Yoshikai Masaru, Ito Tsuyoshi, Kamohara Keiji, Yunoki Junji
Department of Cardiovascular Surgery, Shin-Koga Hospital, 120 Tenjin-cho, Kurume, 830-8577, Fukuoka, Japan.
Eur J Cardiothorac Surg. 2004 Feb;25(2):208-11. doi: 10.1016/j.ejcts.2003.11.013.
The skeletonized internal thoracic artery (ITA) has several advantages over a pedicled one in coronary artery bypass grafting (CABG). An ultrasonic scalpel makes ITA skeletonization easy and speedy, however, the ultrasonic energy that is transmitted to the artery itself can occasionally injure the endothelium. Therefore, the endothelial integrity of the ultrasonically skeletonized ITA is a major concern related to this technique. The purpose of this study is to assess the endothelial integrity of the ultrasonically skeletonized ITA.
We skeletonized the left ITA with an ultrasonic scalpel in nine patients who underwent CABG, and thereafter the terminal portion of this artery was subjected to a morphological study. The endothelial integrity of this artery was morphologically assessed using scanning electron microscopy, and the results were compared to that of the left ITA skeletonized with fine scissors.
All ITA specimens showed a completely confluent endothelium, and no endothelial injury was observed by the scanning electron microscopic study.
The skeletonization of the ITA with an ultrasonic scalpel had no deleterious effect on the endothelium. This morphological study confirmed the safety and the reliability of this technique, and we therefore recommend its clinical use in the skeletonization of the ITA for CABG.
在冠状动脉旁路移植术（CABG）中，骨骼化胸廓内动脉（ITA）相较于带蒂胸廓内动脉具有若干优势。超声刀使ITA骨骼化操作简便且迅速，然而，传递至动脉本身的超声能量偶尔会损伤内皮。因此，超声骨骼化ITA的内皮完整性是与该技术相关的主要关注点。本研究旨在评估超声骨骼化ITA的内皮完整性。
我们在9例行CABG的患者中使用超声刀对左ITA进行骨骼化处理，随后对该动脉的末端部分进行形态学研究。使用扫描电子显微镜对该动脉的内皮完整性进行形态学评估，并将结果与用精细剪刀骨骼化的左ITA进行比较。
所有ITA标本均显示内皮完全融合，扫描电子显微镜研究未观察到内皮损伤。
用超声刀对ITA进行骨骼化处理对内皮无有害影响。这项形态学研究证实了该技术的安全性和可靠性，因此我们建议在CABG中对ITA进行骨骼化处理时临床应用该技术。
