关键词: 内窥镜；大隐静脉管径；损伤；细胞凋亡

Abstract:

Objective   To compare the influence of saphenous diameters on the operative progress and vessel condition of endoscopic saphenous vein harvesting (ESVH). Methods   The clinical cases of 80 patients who were treated with ESVH from 2011 to 2012 in our hospital were investigated. Patients were divided into two groups by preoperative ultrasound: group A (SV caliber <3mm, n=19), and group B (SV caliber≥3mm, n=61). Total procedure time and EVSH time, SV characteristics such as the total number of side branches, number of ligated branches, number of repaired branches, and total graft length were recorded in the operating room.Light microscopy was used to observe the structure of the vein intima, scanning electron microscopy was used to assess the trauma of the vein intima, and the cell apoptosis was detected by TUNEL assay. Results   Group A had a larger number of side branches (A, 12.9±3.2; B, 9.3±4.1，P<0.05), but graft length ［A, (28.2±3.9)cm; B, (27.7±3.1)cm］ and ratio of repaired side branches relative to total branches per graft ［A, (20.3±9.1)%; B, (18.5±8.0)%］ showed no significant inter-group differences（P>0.05）. Group A patients required a longer operating time ［A, (59.5±12.8)min; B, (41.9±15.4)min］, but EVSH time showed no difference（P>0.05）.Vascular histological injury was statistically significant(P<0.05)，but the cell apoptosis detected by TUNEL assay showed no significant differences(P>0.05). Conclusion   SV with a caliber of <3mm prolong the procedure time and injure the quality of SV in comparison with SV measuring ≥3mm in caliber. So SV with a small caliber is less appropriate for ESVH and is better harvested by a conventional open procedure.

Key words: Endoscopic； Saphenous diameter； Injury； Apoptosis