开放式与内镜下大隐静脉切除术期间内皮细胞损伤的比较研究：电子显微镜评估

A comparative study of endothelial cell injury during open and endoscopic saphenectomy: an electron microscopic evaluation.

作者信息

Alrawi S J, Balaya F, Raju R, Cunningham J N, Acinapura A J

机构信息

Maimonides Medical Center, Department of Surgery, Brooklyn, New York, USA.

出版信息

Heart Surg Forum. 2001;4(2):120-7.

PMID:11544622

Abstract

BACKGROUND

The role of damaged endothelium in early graft occlusion has been extensively demonstrated. Seventy percent of early graft occlusions in coronary artery bypass were caused by thrombi overlying areas of endothelial loss. With the increased use of endoscopic vein harvesting, it becomes important to study the extent of endothelial damage by light and electron microscopy. In this study, we compared the degree of endothelial damage inflicted by the open and endoscopic techniques of vein harvesting using light, scanning, and transmission electron microscope.

MATERIAL AND METHODS

Ninety samples of saphenous veins from 45 patients prepared for coronary artery bypass grafting (CABG) utilizing both endoscopic and standard open incision techniques were examined using light, scanning, and transmission electron microscopy. These vein samples were prepared in Plasma-lyte solution (Baxter) in combination with or without papaverine, at two distending pressures of 100 or 300 mmHg and at temperatures of either 4 degrees C or 28 degrees C in eight subgroups and one control group. The pathological alterations in the saphenous veins were graded either based on a scoring system (0 = none, 1 = < 10%, 2 = 10-25%, 3 = 25-50%, 4 = > 50%) to assess the degree of damage inflicted by these two different types of saphenectomies or by electron microscopic observed abnormalities, including endothelial cell (EC) separation, EC detachment, basement membrane (BM) exposure, collagen exposure, and EC edema.

RESULTS

Using cross-tabulation and Chi-square statistical analysis, we found that the differences in the degree of endothelial damage using either of the techniques is not statistically significant (P > 0.05).

CONCLUSION

Our findings indicate that endoscopic and open saphenectomies are technically comparable as far as structural damage is concerned, rendering the endoscopic technique of vein handling the preferred method for CABG.

摘要

背景

受损内皮在早期移植物闭塞中的作用已得到广泛证实。冠状动脉搭桥术中70%的早期移植物闭塞是由内皮缺失区域上覆盖的血栓引起的。随着内镜下静脉采集的使用增加，通过光学显微镜和电子显微镜研究内皮损伤的程度变得很重要。在本研究中，我们使用光学显微镜、扫描电子显微镜和透射电子显微镜比较了开放和内镜静脉采集技术造成的内皮损伤程度。

材料与方法

对45例准备进行冠状动脉搭桥术（CABG）的患者的90个大隐静脉样本进行了检查，这些样本采用内镜和标准开放切口技术获取，并使用光学显微镜、扫描电子显微镜和透射电子显微镜观察。这些静脉样本在含有或不含罂粟碱的血浆电解质溶液（百特公司）中制备，在两个扩张压力（100或300 mmHg）和两个温度（4℃或28℃）下分为八个亚组和一个对照组。大隐静脉的病理改变根据评分系统（0 = 无，1 = < 10%，2 = 10 - 25%，3 = 25 - 50%，4 = > 50%）进行分级，以评估这两种不同类型的大隐静脉切除术造成的损伤程度，或通过电子显微镜观察到的异常情况进行评估，包括内皮细胞（EC）分离、EC脱离、基底膜（BM）暴露、胶原暴露和EC水肿。