课题背景：研究证明，大隐静脉采集、制备及储备过程中造成的血管内皮细胞损伤将直接影响大隐静脉旁路血管的长期通畅率。内窥镜辅助采集大隐静脉的最大受益是与传统的全程切开方式相比明显降低了伤口并发症的发生率，但与此同时内窥镜辅助是否加重血管损伤也受到人们的关注。

临床应用性：文章通过对比传统的全程切开与内窥镜辅助两种方案采集大隐静脉的组织学改变，评价内窥镜辅助采集对大隐静脉的组织学损伤情况。结果发现与传统的全程切开相比，内窥镜辅助未增加对大隐静脉的组织学损伤。

同行评价；文章为短期临床观察，内窥镜辅助采集大隐静脉的临床效果还需长期临床试验。同时还存在样本量少，观察指标主观性，标本取材部位受临床限制等不足。

摘要

背景：保持大隐静脉旁路材料结构和功能的完整性对于维持良好的远期通畅率至关重要。
目的：对比传统全程切开与内窥镜辅助两种方案采集的大隐静脉组织学改变，评价内窥镜辅助采集对大隐静脉的组织学损伤情况。
设计、时间及地点：病例对比观察，于2006-06/2007-03在解放军北京军区总医院心肺血管中心外科完成。
对象：应用大隐静脉为旁路移植材料择期行非体外循环冠状动脉搭桥术的患者60例，根据手术方案分为2组，内窥镜辅助组及全程切开组各30例。
方法：两组分别采用传统全程切开皮肤方式和内窥镜辅助方式采集大隐静脉。
主要观察指标：应用苏木精-伊红、Marson 3色和弹力纤维3种方法染色，光镜下从组织连续性、均匀一致性方面评价大隐静脉内皮细胞层、内膜下弹力纤维层、中层平滑肌层及外膜层血管损伤程度。
结果：内窥镜辅助组及全程切开组患者大隐静脉内皮细胞层、内膜下弹力纤维层、平滑肌层、外膜层血管损伤程度差异无显著性意义（P﹥0.05）。
结论：与传统的全程切开方案相比，内窥镜辅助采集大隐静脉未增加对大隐静脉的组织学损伤。
关键词：血管/移植；冠状动脉旁路移植术；内窥镜检查；隐静脉；组织移植

王东文，张永，姚建民，肖志斌，赵向东.内窥镜辅助与全程切开采集大隐静脉的组织学变化[J].中国组织工程研究与临床康复，2008，12(18):3567-3570 [www.zglckf.com/zglckf/ejournal/upfiles/08-18/18k-3567(ps).pdf]

Histological alterations of endoscopic versus open saphenous vein harvesting in coronary artery bypass surgery

Abstract

BACKGROUND: Structural and functional integrity of bypass materials of great saphenous vein plays an important role in maintaining long-term patency.
OBJECTIVE: To assess the vascular trauma of saphenous vein conduits by endoscopic saphenous vein harvesting (EVH) compared with those by conventional open saphenous vein harvesting (OVH).
DESIGN, TIME AND SETTING: Case comparative observation was performed at Department of Cardiovascular Surgery, General Hospital of Beijing Military Area Command of Chinese PLA between June 2006 and March 2007.
PARTICIPANTS: Sixty patients undergoing bypass non-extracorporeal circulation coronary artery bypass grafting using saphenous vein as bypass graft were selected and randomly divided into EVH group and OVH group (n=30).
METHODS: Saphenous vein was collected by EVH and OVH methods, respectively.
MAIN OUTCOME MEASURES: Harvested vein specimens were stained by hematoxylin-eosin, Mason’s trichrome, and elastin. The histologic structures were evaluated in the vascular endothelial layer, vascular elastic lamina, vascular smooth muscle and adventitial connective tissue, respectively.
RESULTS: There were no significant differences in the impairment scale of vascular endothelial layer, vascular elastic lamina, vascular smooth muscle and adventitial connective tissue between two groups (P > 0.05).
CONCLUSION: EVH does not induce greater histologic trauma during saphenous vein collection than that observed with OVH.

Wang DW, Zhang Y, Yao JM, Xiao ZB, Zhao XD.Histological alterations of endoscopic versus open saphenous vein harvesting in coronary artery bypass surgery.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(18):3567-3570(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-18/18k-3567(ps).pdf]