Lorberboym M, Medalion B, Bder O, Lockman J, Cohen N, Schachner A, Cohen A J
Department of Nuclear Medicine, The Edith Wolfson Medical Center, Holon, Israel.
Nucl Med Commun. 2002 Jan;23(1):47-52. doi: 10.1097/00006231-200201000-00008.
Coronary artery bypass grafting (CABG) is one of the most frequently performed operations in the United States. The use of internal mammary artery (IMA) grafting has been identified as increasing the risk of sternal wound infections and mediastinitis. The purpose of our study was to prospectively evaluate the effect of different techniques of left internal mammary artery (LIMA) harvesting on sternal vascularity. Thirty-three patients undergoing primary coronary artery bypass grafting were studied. The patients were divided into groups that received a skeletonized IMA (group I, n=11), a pedicled IMA (group II, n=12), or a semiskeletonized IMA (group III, n=10) graft. Each patient underwent a preoperative 99mTc-methylene diphosphonate bone scan using single photon emission computed tomography (SPECT). The ratio of the mean counts/pixel for each side of the sternum was obtained. Post-operatively, all patients had a repeat bone SPECT. Ratios of unilateral sternal uptakes were compared to the preoperative study. A univariable analysis of post-operative to pre-operative ratios revealed statistically significant reduction in vascularity to the left side of the sternum post-operatively in group II compared with groups I and III (0.68 0.12 vs 0.99 0.24 and 0.93 0.09; P<0.01). There was no difference between groups I and III (P=1). Multivariable analysis revealed only the type of harvesting to be associated with post-operative reduction in left to right sternal activity ratio (P<0.02). Pairwise comparisons revealed that differences are due to pedicled type of harvesting (group II vs group I, P=0.03; II vs III, P=0.001; and I vs III, P=0.115). A pedicled IMA graft causes acute post-operative sternal ischaemia. This does not occur when the IMA is skeletonized or semiskeletonized. Hence, it may be prudent to minimize dissection during mobilization of the IMA to decrease the likelihood of post-operative sternal complications.
冠状动脉旁路移植术（CABG）是美国最常开展的手术之一。使用乳内动脉（IMA）进行移植已被认定会增加胸骨伤口感染和纵隔炎的风险。我们研究的目的是前瞻性评估不同的左乳内动脉（LIMA）获取技术对胸骨血运的影响。对33例行初次冠状动脉旁路移植术的患者进行了研究。这些患者被分为接受骨骼化IMA（I组，n = 11）、带蒂IMA（II组，n = 12）或半骨骼化IMA（III组，n = 10）移植的组。每位患者术前使用单光子发射计算机断层扫描（SPECT）进行了99mTc-亚甲基二膦酸盐骨扫描。获取了胸骨两侧平均计数/像素的比值。术后，所有患者均再次进行了骨SPECT检查。将单侧胸骨摄取比值与术前研究结果进行比较。对术后与术前比值的单变量分析显示，与I组和III组相比，II组术后胸骨左侧血运在统计学上有显著降低（0.68±0.12 vs 0.99±0.24和0.93±0.09；P<0.01）。I组和III组之间无差异（P = 1）。多变量分析显示，只有获取类型与术后左右胸骨活动比值降低相关（P<0.02）。两两比较显示，差异是由于带蒂获取类型所致（II组与I组比较，P = 0.03；II组与III组比较，P = 0.001；I组与III组比较，P = 0.115）。带蒂IMA移植会导致术后急性胸骨缺血。当IMA被骨骼化或半骨骼化时不会发生这种情况。因此，在IMA游离过程中尽量减少解剖操作以降低术后胸骨并发症的可能性可能是明智的。
