Inoue S, Harada R, Obama T, Naraoka S, Hashimoto M, Niida Y
Department of Thoracic and Cardiovascular Surgery, Hokkaido Prefectural Kitami Hospital, Kitami, Japan.
Kyobu Geka. 2011 Jul;64(7):523-6; discussion 527-9.
The aim of this study is to compare the frequency of wound infection between bilateral and single internal thoracic artery (ITA) harvesting in coronary artery bypass grafting (CABG) cases. Two hundreds and thirty-four consecutive CABG cases performed harvesting either bilateral ITA (BITA) or single ITA (SITA) from January 2004 to December 2008, with or without concomitant surgery were studied. Harmonic Scalpel was used for the harvesting with skeletonization technique. The cases were divided into 2 groups: BITA group (n = 180) and SITA group (n = 54). The frequencies of wound infection were 3.7% in SITA group and 6.1% in BITA group. As to deep sternal infection, they were 1.9% in SITA group and 1.1% in BITA group. There was no significant difference between the 2 groups. Multivariate analysis of all patients showed that emergency cases, hypertension, congestive heart failure, and reopening for bleeding were identified as independent risk factors for wound infection. There were 113 diabetes mellitus (DM) patients out of all patients ; SITA group (n = 22) and BITA group (n = 91). Their wound infection rates were 4.5% and 6.6%, and those of deep sternal infection were 0% and 2.2%, respectively. There was no significant difference between them. In conclusion, BITA harvesting with skeletonized technique may be used as safely as SITA harvesting even in DM patients.
本研究的目的是比较冠状动脉旁路移植术(CABG)中双侧和单侧胸廓内动脉(ITA)采集情况下伤口感染的发生率。研究了2004年1月至2008年12月期间连续进行的234例CABG病例,这些病例采用双侧ITA(BITA)或单侧ITA(SITA)采集,无论是否伴有其他手术。使用超声刀采用骨骼化技术进行采集。病例分为两组:BITA组(n = 180)和SITA组(n = 54)。SITA组伤口感染发生率为3.7%,BITA组为6.1%。至于深部胸骨感染,SITA组为1.9%,BITA组为1.1%。两组之间无显著差异。对所有患者进行多因素分析显示,急诊病例、高血压、充血性心力衰竭和因出血再次手术被确定为伤口感染的独立危险因素。所有患者中有113例糖尿病(DM)患者;SITA组(n = 22)和BITA组(n = 91)。他们的伤口感染率分别为4.5%和6.6%,深部胸骨感染率分别为0%和2.2%。两者之间无显著差异。总之,即使在DM患者中,采用骨骼化技术进行BITA采集与SITA采集一样安全。