| Objective:In this article,prospective randomized controlled study of endoscopic contrast to the traditional division cut method to get great saphenous vein used in off-pump coronary artery bypass grafting,to evaluate their clinical outcome,to explore its value and future prospects.Methods:A total of 569 patients from October 2006 to October 2008 scheduled for coronary artery bypass operation were divided into two groups for randomized comparison,either Endoscopic Group n=303 using the endoscopic technique(A) or Routine Group n=266 using traditional technique(B).Comparison 1:Age,gender,DM,stenosis of lower limb artery,smoking,long term steroids,Anticoagulants;Comparison 2:Total harvesting time,pure vein harvesting time,the quality of vessel harvesting,the number of grafts;Comparison 3:Total postoperative complications;Comparison 4:Early postoperative local complications:Disruption of wound,infection,skin edge necrosis,haematoma, lipolyse,cacesthesia,pain,lower extremity edema;Comparison 5:Early postoperative general complications:Death,new cardiac event,deep vein thrombosis, bed pneumonia for lower limb pain;Comparison 6:The recovery after operation: Walk postoperative,length of stay,pigmentation,numbnes,duration of the complications;Comparison 7:Cost.Statistics:Data are processed by SPSS 11.5 software Package,the testing level isα=0.05.Lost follow-up of post operation and the impact on the final outcome are analyzed.Results:In this study,all patients saphenous veins harvesting were performed successfully.Only 16 of them altered to the other side successfully because of greater saphenous vein malformation,too close to skin,poor vessel wall or too many branches.Base line comparison in two groups shows that there are no statistical significance in age,gender,DM,stenosis of lower limb artery,smoking,long term steroids,Anticoagulants(P＞0.05),and there is statistical difference in independent risk factor obesity and it is higher in Group A than in Group B(P＜0.05).It suggests that patients in Endoscopic Group are in higher risk after operation.Total harvesting times are shorter in Group A than in Group B(P＜0.001).Pure veins harvesting times are longer in Group B than in Group A(P＜0.001).The times to close an incision,A＜B(P＜0.001).In the quality of vessel harvesting,it shows that the ratio of vessel injures is lower than the traditional technique and there is statistical significance because of euthyphoria on TV screen operation(P＜0.01).The number of grafts,A＞B(P＜0.001).Total postoperative complications is lower in Group A(P＜0.005).Early postoperative local complications:disruption of wound is no significance in two groups(P＞0.05),there are statistic differences in infection(P＜0.025) and skin edge necrosis(P＜0.05).Group A has absolute advantages in postoperative haematoma(P＜0.01),lipolyse(P＜0.005),cacesthesia(P＜0.005),pain(P＜0.005),lower extremity edema(P＜0.005).Comparison of early postoperative general complication:there is no death,new cardiac event,deep vein thrombosis occurred in two groups.Group A better than Group B in bed pneumonia for lower limb pain(P＜0.05).The recovery after operation:According to the recovery after operation,the patients Group A can walk earlier(P＜0.001).According to the duration of the long-term complications such as pigmentation or numbness,the patients Group A are shorter(P＜0.001),and the patients Group B have the complications far more serious. But the duration of the complications between two groups has no difference(P＞0.5). The total ratio lost to follow-up less than 5%,there is no impact no the results.The cost of operation:A＞B;the total cost of patient:A＜B(P＜0.05).Conclusions:The endoscopic greater saphenous vein harvesting is safe and reliable, it has advantages of less hurt to havest greater saphenous vein,decreasing peroperative complicates and complaints.It can be considered becoming undoubtedly the procedure of choice for harvesting vessel conduits.
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