van Son J A, Tavilla G, Noyez L
Department of Thoracic and Cardiac Surgery, University Hospital Nijmegen St. Radboud, The Netherlands.
J Thorac Cardiovasc Surg. 1992 Oct;104(4):972-6.
We studied the effect of hydrostatic dilation of the internal mammary artery used for coronary revascularization in 10 patients (aged 45 to 79 years, median 63 years). Diluted papaverine solution was injected in the lumen of distal segments of the internal mammary artery, the musculophrenic artery, or the superior epigastric artery that had been obtained at operation; injection was followed by hydrostatic dilation not exceeding a sheer force of 50 gm. In 12 control patients (aged 42 to 76 years, median 64 years) in whom the internal mammary artery had also been harvested for elective myocardial revascularization, similar arterial segments were wrapped in sponges soaked in papaverine solution of the same dilution. In the nondilated group the median (with interquartile range) number of fenestrations in the internal elastic lamina increased from the elastic (21, 7) to the elastomuscular (41, 11) and muscular segments (89, 12) (elastic-elastomuscular: p = 0.006; elastic-muscular: p = 0.006; elastomuscular-muscular: p = 0.003) (Wilcoxon signed-rank test). In none of the three histologic segments were full-thickness disruptions of the intima and disruptions of the internal elastic lamina seen. Similarly, in the dilated group the number of fenestrations in the internal elastic lamina increased from the elastic (25, 18) to the elastomuscular (43, 9) and muscular (100, 13) segments (p values 0.01, 0.01, and 0.006, respectively). In addition, in 20% of the elastic sections, in 17% of the elastomuscular sections, and in 35% of the muscular sections of the dilated group, disruptions of the intima and internal elastic lamina were seen. Comparison of the number of fenestrations in internal elastic lamina in the three histologic segments between the nondilated and dilated groups revealed a significantly greater value in the muscular segments of the latter group (p = 0.01) (Mann-Whitney U test). We concluded that (1) hydrostatic dilation of the internal mammary, musculophrenic, and superior epigastric arteries may have detrimental effects on the histologic characteristics of the intima and the internal elastic lamina and (2) the number of fenestrations in the internal elastic lamina of these arteries is related to the presence or absence of elastic lamellae in the media.
我们研究了用于冠状动脉血运重建的乳内动脉进行液压扩张的效果，研究对象为10例患者（年龄45至79岁，中位数63岁）。将稀释的罂粟碱溶液注入手术中获取的乳内动脉、肌膈动脉或腹壁上动脉远端节段的管腔内；注射后进行液压扩张，扩张力不超过50克。在另外12例同样为择期心肌血运重建而获取乳内动脉的对照患者（年龄42至76岁，中位数64岁）中，将类似的动脉节段包裹在浸泡于相同稀释度罂粟碱溶液的海绵中。在未扩张组中，内弹性膜的窗孔数量中位数（四分位间距）从弹性段（21, 7）增加到弹性肌性段（41, 11）和肌性段（89, 12）（弹性段-弹性肌性段：p = 0.006；弹性段-肌性段：p = 0.006；弹性肌性段-肌性段：p = 0.003）（Wilcoxon符号秩检验）。在内膜全层破坏和内弹性膜破坏方面，三个组织学节段均未观察到。同样，在扩张组中，内弹性膜的窗孔数量从弹性段（25, 18）增加到弹性肌性段（43, 9）和肌性段（100, 13）（p值分别为0.01、0.01和0.006）。此外，在扩张组的20%弹性段、17%弹性肌性段和35%肌性段中，观察到了内膜和内弹性膜的破坏。未扩张组和扩张组三个组织学节段内弹性膜窗孔数量的比较显示，后者肌性段的值显著更高（p = 0.01）（Mann-Whitney U检验）。我们得出结论：（1）乳内动脉、肌膈动脉和腹壁上动脉的液压扩张可能对内膜和内弹性膜的组织学特征产生有害影响；（2）这些动脉内弹性膜的窗孔数量与中膜弹性板的有无相关。
