中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

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不接触技术对冠状动脉旁路移植术后血管通畅度影响的系统评价与 Meta 分析

周小宇 , 郭炯 , 黄辰 , 舒礼良 , 徐敬

郑州大学第一附属医院 心外三科（郑州  450000）

收稿日期: 2017-12-11;  修回日期:2018-01-16; 

基金项目: 国家自然科学基金青年科学基金项目（81700236）

通讯作者: 徐敬, Email: xujing00111@sina.com

Effect of no-touch technique in coronary artery bypass grafting’s vascular patency: A systematic review and meta-analysis

ZHOU Xiaoyu , GUO Jiong , HUANG Chen , SHU Liliang , XU Jing

The Third Department of Cardiac Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, P.R.China

Corresponding Author: XU Jing, Email: xujing00111@sina.com

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目的 评价采用不接触技术与传统技术行冠状动脉旁路移植术（CABG）术后血管通畅度的差异。 方法 检索 1997 年 1 月至 2017 年 11 月发表在 PubMed、Cochrane Library、中国期刊全文数据库、万方数据库等有关不接触技术与传统技术对比的相关文献。采用 Jadad 评分进行文献质量评价。应用 RevMan 5.0 软件进行 Meta 分析。 结果 共纳入 6 个随机对照研究，Jadad 评分均为 5 分。Meta 分析结果显示，两组术后死亡（1 个月内）差异无统计学意义［RR=0.68，95%CI（0.11，4.11），P=0.67］。两组术后腿部愈合不良差异无统计学意义［RR=1.46，95%CI（0.23，9.16），P=0.68］。两组短期心源性死亡（12～18 个月）差异无统计学意义［RR=0.33，95%CI（0.10，1.03），P=0.06］，长期心源性死亡（6～8 年）差异有统计学意义［RR=0.36，95%CI（0.16，0.79），P=0.01］。不接触技术组短期（12～18 个月）随访通畅率较传统技术组更高，差异有统计学意义［MD=2.64，95%CI（1.81，3.85），P<0.01］。不接触技术组长期（6～8 年）通畅率较传统技术组更高，差异具有统计学意义［MD=3.08，95%CI（1.58，5.99），P<0.01］。 结论 在 CABG 中，不接触技术取材大隐静脉较传统技术相比可以提高长期存活率，可以提高患者冠状动脉桥血管的短期、长期通畅率。

Objective To analyze the efficacy of no-touch technique and traditional technique in drawing great saphenous vein during coronary artery bypass grafting. Methods We searched the literatures on no-touch technique versus traditional technique in drawing great saphenous vein during coronary artery bypass grafting in PubMed, Cochrane Library, Chinese Journal Full-text Database, Wanfang database between January 1997 and November 2017. Jadad scale was used for quality verification. RevMan 5.0 was used for analysis. Results Six studies were included. Jadad scale for both 6 randomized controlled trials was 5 points. Meta-analysis showed that there was no statistical difference in postoperative mortality between the two groups with RR=0.68 and 95%CI 0.11 to 4.11(P=0.67). There was no statistical difference in leg wounds with RR=1.46 and 95%CI 0.23 to 9.16 (P=0.68). There was no statistical difference in short-term cardiogenic death with RR=0.33, 95%CI 0.10 to 1.03 ( P=0.06). The no-touch group’s long-term cardiogenic death was significantly lower than the traditional group withRR=0.36, 95%CI 0.16 to 0.79(P=0.01). Postoperative no-touch group’s short-term patency rate was significantly better than that of the traditional group with MD=3.08 and 95%CI 1.58 to 5.99 (P<0.01). The long-term patency rate in the no-touch group was also higher than that of the traditional group withMD=3.08 and 95%CI 1.58 to 5.99 (P<0.01). Conclusion Compared with the traditional group, the no-touch group increases postoperative long-term survival rate, short-term and long-term patency rate.

关键词: 大隐静脉; 冠状动脉旁路移植术; 不接触技术; 系统评价/Meta 分析

Key words: Saphenous vein; coronary artery bypass graft; non-touch technique; systematic review/meta-analysis

引用本文： 周小宇, 郭炯, 黄辰, 舒礼良, 徐敬. 不接触技术对冠状动脉旁路移植术后血管通畅度影响的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1032-1037. doi: 10.7507/1007-4848.201712027 复制

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1. Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med, 2012, 367(25): 2375-2384.
2. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
3. 胡盛寿, 郑哲, 周玉燕. 常规与非体外循环冠状动脉旁路移植术治疗冠状动脉多支病变的对比分析. 中国胸心血管外科临床杂志, 2000, 6(4): 221-224.
4. Izzat MB, West RR, Bryan AJ, et al. Coronary artery bypass surgery: current practice in the United Kingdom. Br Heart J, 1994, 71(4): 382-385.
5. Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol, 2004, 44(11): 2149-2156.
6. Cooper G J, Underwood M J, Deverall P B. Arterial and venous conduits for coronary artery bypass. A current review. European J Cardio-thorac Surg, 1996, 10(2): 129-140.
7. Mehta D, Izzat MB, Bryan AJ, et al. Towards the prevention of vein graft failure. Int J Cardiol, 1997, 62(Suppl 1): S55-S63.
8. Izzat MB, West RR, Bryan AJ, et al. Coronary artery bypass surgery: current practice in the United Kingdom. Br Heart J, 1994, 71(4): 382-385.
9. Deb S, Cohen EA, Singh SK, et al. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: results from RAPS (Radial Artery Patency Study). J Am Coll Cardiol, 2012, 60(1): 28-35.
10. Sepehripour A H, Jarral O A, Shipolini A R, et al. Does a ’no-touch’ technique result in better vein patency? Inter Cardiovasc Thorac Surg, 2011, 13(6): 626-630.
11. Angelini GD, Passani SL, Breckenridge IM, et al. Nature and pressure dependence of damage induced by distension of human saphenous vein coronary artery bypass grafts. Cardiovasc Res, 1987, 21(12): 902-907.
12. Ahmed SR, Johansson BL, Karlsson MG, et al. Human saphenous vein and coronary bypass surgery: ultrastructural aspects of conventional and " no-touch” vein graft preparations. Histol Histopathol, 2004, 19(2): 421-433.
13. Dashwood MR, Savage K, Tsui JC, et al. Retaining perivascular tissue of human saphenous vein grafts protects against surgical and distension-induced damage and preserves endothelial nitric oxide synthase and nitric oxide synthase activity. J Thorac Cardiovasc Surg, 2009, 138(2): 334-340.
14. Samano N, Geijer H, Liden M, et al. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: A randomized trial. J Thorac Cardiovasc Surg, 2015, 150(4): 880-888.
15. 张岩, 孙寒松, 胡盛寿. 不接触技术对冠状动脉旁路移植术后静脉桥通畅率影响的进展. 中国胸心血管外科临床杂志, 2016, 23(8): 827-831.
16. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
17. Rueda Fd, Souza D, Lima Rde C, et al. Novel no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting. Arq Bras Cardiol, 2008, 90(6): 356-362.
18. Souza DS, Dashwood MR, Tsui JC, et al. Improved patency in vein grafts harvested with surrounding tissue: results of a randomized study using three harvesting techniques. Ann Thorac Surg, 2002, 73(4): 1189-1195.
19. Johansson BL, Souza DS, Bodin L, et al. Slower progression of atherosclerosis in vein grafts harvested with ’no touch’ technique compared with conventional harvesting technique in coronary artery bypass grafting: an angiographic and intravascular ultrasound study. Eur J Cardiothorac Surg, 2010, 38(4): 414-419.
20. Kim YH, Oh HC, Choi JW, et al. No-touch saphenous vein harvesting may improve gurther the patency of daphenous vein composite grafts: early outcomes and 1-year angiographic results. Ann Thorac Surg, 2017, 103(5): 1489-1497.
21. Verma S, Lovren F, Pan Y, et al. Pedicled no-touch saphenous vein graft harvest limits vascular smooth muscle cell activation: the PATENT saphenous vein graft study. Eur J Cardiothorac Surg, 2014, 45(4): 717-725.
22. Parang P, Arora R. Coronary vein graft disease: pathogenesis and prevention. Can J Cardiol, 2009, 25(2): e57-e62.
23. Tsui JC, Souza DS, Filbey D, et al. Localization of nitric oxide synthase in saphenous vein grafts harvested with a novel " no-touch” technique: potential role of nitric oxide contribution to improved early graft patency rates. J Vasc Surg, 2002, 35(2): 356-362.
24. Souza DS, Arbeus M, Botelho PB, et al. The no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting surgery. Multimed Man Cardiothorac Surg, 2009, 2009(731): 345-348.
25. Khaleel MS, Dorheim TA, Duryee MJ, et al. High-pressure distention of the saphenous vein during preparation results in increased markers of inflammation: a potential mechanism for graft failure. Ann Thorac Surg, 2012, 93(2): 552-558.
26. Nolte A, Secker S, Walker T, et al. Veins are no arteries: even moderate arterial pressure induces significant adhesion molecule expression of vein grafts in an ex vivo circulation model. J Cardiovasc Surg, 2011, 52(2): 251-259.
27. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulation, 1998, 97(9): 916-931.
28. Dashwood MR, Savage K, Dooley A, et al. Effect of vein graft harvesting on endothelial nitric oxide synthase and nitric oxide production. Ann Thorac Surg, 2005, 80(3): 939-944.
29. Souza DS, Johansson B, Bojö L, et al. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial. J Thorac Cardiovasc Surg, 2006, 132(2): 373-378.
30. Mannion JD, Marelli D, Brandt T, et al. " No-touch” versus " endo” vein harvest: early patency on symptom-directed catheterization and harvest site complications. Innovations (Phila), 2014, 9(4): 306-311.
31. Papakonstantinou NA, Baikoussis NG, Goudevenos J, et al. Novel no touch technique of saphenous vein harvesting: Is great graft patency rate provided? Ann Card Anaesth, 2016, 19(3): 481-488.
32. Mountney J, Wilkinson GA. Saphenous neuralgia after coronary artery bypass grafting. Eur J Cardiothorac Surg, 1999, 16(4): 440-443.
33. Sastry P, Rivinius R, Harvey R, et al. The influence of endoscopic vein harvesting on outcomes after coronary bypass grafting: a meta-analysis of 267, 525 patients. Eur J Cardiothorac Surg, 2013, 44(6): 980-989.