Division of Cardiothoracic Surgery, Star Hospitals, Banjara Hills, Hyderabad, India.
J Thorac Cardiovasc Surg. 2012 Aug;144(2):480-5. doi: 10.1016/j.jtcvs.2012.03.024. Epub 2012 Apr 11.
We compared sternal wound infections between diabetic patients undergoing off-pump coronary artery bypass surgery using bilateral internal thoracic artery grafting or single internal thoracic artery grafting and nondiabetic patients receiving bilateral internal thoracic artery or single internal thoracic artery grafting using a modified pedicled harvest technique of internal thoracic artery.
This retrospective study was conducted to analyze the data from 3072 patients who underwent primary coronary artery bypass surgery using an off-pump technique from August 2004 to October 2010. Of the 1211 diabetic patients, 181 received bilateral internal thoracic artery grafts (group 1) and 1030 received single internal thoracic artery grafts (group 2). Of the 1861 nondiabetic patients, 161 received bilateral internal thoracic artery grafts (group 3) and 1700 received single internal thoracic artery grafts (group 4). The incidence of postoperative sternal wound infections in diabetic patients who received bilateral internal thoracic artery grafting was compared with the incidence in other groups (group 2, 3, and 4). A modified technique of pedicled harvesting of the internal thoracic artery was done in patients receiving bilateral internal thoracic artery grafting, and a standard pedicled harvest was used in patients receiving single internal thoracic artery grafts.
No significant differences were present in the preoperative variables among the groups. The observed rate of superficial sternal wound infections in groups 1, 2, 3, and 4 was 1.1% (2 patients), 1.65% (17 patients), 1.86% (3 patients), and 1.65% (28 patients), respectively (P=.9941). Deep sternal infections were observed in 1 (0.55%), 5 (0.48%), 1 (0.62%), and 14 patients (0.82%) in groups 1 through 4, respectively (P=.8380). Multivariate analysis showed that bilateral internal thoracic artery harvesting (P=.889), diabetes mellitus (P=.96), and patient age were not predictors of sternal wound infection.
The results of the present study show that there is no increase in the incidence of sternal wound infections in diabetic patients undergoing coronary artery bypass surgery with bilateral internal thoracic artery grafting by using a modified pedicle bilateral internal thoracic artery harvesting technique with sparing of the communicating bifurcation of internal thoracic artery to the chest wall and preservation of pericardiacophrenic artery branch.
比较双侧内乳动脉搭桥术与单侧内乳动脉搭桥术治疗糖尿病患者和非糖尿病患者开胸冠状动脉旁路移植术后胸骨伤口感染的情况，均采用改良的带蒂内乳动脉游离技术。
回顾性分析 2004 年 8 月至 2010 年 10 月 3072 例行非体外循环冠状动脉旁路移植术患者的数据。1211 例糖尿病患者中，181 例行双侧内乳动脉搭桥术（1 组），1030 例行单侧内乳动脉搭桥术（2 组）。1861 例非糖尿病患者中，161 例行双侧内乳动脉搭桥术（3 组），1700 例行单侧内乳动脉搭桥术（4 组）。比较糖尿病患者行双侧内乳动脉搭桥术后胸骨伤口感染的发生率与其他组（2 组、3 组和 4 组）的发生率。双侧内乳动脉搭桥患者采用改良的带蒂内乳动脉游离技术，单侧内乳动脉搭桥患者采用标准的带蒂游离技术。
各组间术前变量无显著差异。1 组、2 组、3 组和 4 组患者的浅表性胸骨伤口感染发生率分别为 1.1%（2 例）、1.65%（17 例）、1.86%（3 例）和 1.65%（28 例）（P=.9941）。深部胸骨感染分别发生于 1 组（0.55%）、5 组（0.48%）、1 组（0.62%）和 4 组（14 例，0.82%）（P=.8380）。多因素分析显示，双侧内乳动脉游离（P=.889）、糖尿病（P=.96）和患者年龄不是胸骨伤口感染的预测因素。
本研究结果表明，采用改良的带蒂双侧内乳动脉游离技术，保留内乳动脉与胸壁的交通支，保留心大神经外侧支，行双侧内乳动脉搭桥术治疗糖尿病患者，不增加开胸冠状动脉旁路移植术后胸骨伤口感染的发生率。
