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投稿时间：2024-04-27 网络发布日期：2024-10-10
投稿时间：2024-04-27 网络发布日期：2024-10-10
中文摘要: 目的 比较腔镜与开放两种桡动脉桥血管获取手术技术的特点和术后并发症情况。方法 回顾性分析2020年1月至2023年10于南京大学医学院附属鼓楼医院接受冠状动脉旁路移植术（搭桥手术）的74例患者的临床资料，按获取桡动脉方式的不同将患者分为腔镜组（采用腔镜技术获取桡动脉，n=21）和开放组（采用常规开放式获取桡动脉，n=53）。获取完桡动脉桥血管，检查其是否能用于搭桥手术中，对两组获取桡动脉技术在术中和术后状况进行比较。结果 两组均成功完成了桡动脉桥血管采集，且检查发现两组获取的桡动脉桥血管均能满足搭桥手术需求，并用于了搭桥手术。腔镜组的桡动脉获取时间为（38.1±8.1）min，而开放组的时间为（40.2±9.2）min，两组比较差异无统计学意义（t=0.914，P=0.364）；在腔镜组中有1例（4.8%）左上肢血肿，开放组有3例（5.7%）左上肢血肿，两组比较左上肢血肿发生率差异无统计学意义（χ2=0.173，P=0.677）；开放组左上肢肿胀和疼痛发生率略高于腔镜组，但差异无统计学意义（18.9% vs 0，χ2=3.109，P=0.078）。开放组和腔镜组神经损伤差异无统计学意义（7.5% vs 4.8%，χ2=0.007，P=0.934）。搭桥术后进行了11~26个月的随访，平均随访时间为18.6个月，术后，所有患者均未报告心绞痛发作的情况。通过冠状动脉CT血管造影重建成像显示，两组患者的血管桥通畅率均为100.00%。结论 与常规开放获取桡动脉技术相比，腔镜获取桡动脉桥血管具有明显优势，它能够显著减小手术切口，有望降低左上肢肿胀和疼痛的发生率，而在术中需要更加精细的操作来减少组织损伤。
Abstract:Objective To compare the characteristics and complications of endoscopic and open techniques for radial artery graft harvesting. Methods A retrospective analysis was conducted on the clinical data of 74 patients who underwent coronary artery bypass grafting (CABG) in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medicine School from January 2020 to October 2023. Patients were divided into two groups based on the method of obtaining the radial artery: the endoscopic group (using laparoscopic radial artery harvesting, n=21) and the open group (using conventional open radial artery harvesting, n=53). After obtaining radial artery grafts, the radial artery grafts were examined to see if they could be used in CABG, and the intraoperative and postoperative status of the radial artery graft technique were compared between the two groups. Results The radial artery grafts were successfully obtained by two techniques,and the examination found that all these grafts could meet the needs of surgery, and were used for CABG. The acquisition time of the radial artery in the endoscopic group was (38.1±8.1) min, while it was (40.2±9.2) min in the open group, and there was no significant statistical difference between two groups (t=0.914, P=0.364). There was 1 case (4.8%) of left upper limb hematoma in the endoscopic group and 3 cases (5.7%) in the open group, and the difference in the incidence of hematoma between the two groups was not significant (χ2=0.173, P=0.677). Compared with the endoscopic group, the open group had a higher incidence of swelling and pain, but the difference was not significant (18.9% vs 0, χ2=3.109, P=0.078). There was no statistically significant difference in nerve injury between the two groups (7.5% vs 4.8%, χ2=0.007, P=0.934). The patients were followed up for 11-26 months after CABG, with an average follow-up time of 18.6 months, and no patients reported any episodes of angina. Through coronary artery CT angiography reconstruction, the patency rate of grafts was 100.00% in both two groups. Conclusion Compared with conventional open access radial artery technology, endoscopic access to radial artery grafts has significant advantages. It can significantly reduce the surgical incision, which is expected to reduce the incidence of left upper limb swelling and pain, and more precise operations during surgery is needed to reduce tissue damage.
文章编号： 中图分类号：R654.3 文献标志码：A
基金项目:国家自然科学基金重大专项（82241212）；国家自然科学基金面上项目（82270346）；江苏省医学重点学科（ZDXK202229）；南京鼓楼医院新技术发展基金（XJSFZJJ201929）
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引用文本：
徐灿，徐锐，罗汉卿，王文哲，江舟，王东进.腔镜获取与常规开放获取桡动脉技术的对比研究[J].中国临床研究,2025,38(3):393-397.
徐灿，徐锐，罗汉卿，王文哲，江舟，王东进.腔镜获取与常规开放获取桡动脉技术的对比研究[J].中国临床研究,2025,38(3):393-397.