Grundfest W S, Litvack F, Sherman T, Carroll R, Lee M, Chaux A, Kass R, Matloff J, Berci G, Swan H J
Ann Surg. 1985 Sep;202(3):394-400. doi: 10.1097/00000658-198509000-00018.
In this study, the development of intraoperative angioscopy, the value of the information obtained, and the problems encountered with the procedure are reported. Eight angioscopes, 1.5 to 2.8 mm in diameter, with a line resolution of greater than 0.4 mm at 5 mm, were used. One-hundred ten angioscopic investigations were performed in 46 patients; 24 at peripheral bypass surgery and 22 at coronary artery bypass surgery. These included 68 arteries, 28 new anastomoses, six old grafts, five laser angioplasties, and three in situ vein grafts. The most important finding was that angioscopic data provide information not available from probes or angiography. Angioscopic findings were responsible for a change in surgical procedures in 12 patients (26%) including three anastomotic revisions, three alterations in graft site placement, and two repeat thrombectomies. The most significant technical problems were lack of steerability and insufficient irrigation, which resulted in poor angiographic images. Further technical development is necessary before routine intraoperative angioscopy is practical. Nevertheless, if these problems are resolved, angioscopy will provide unique, high-resolution information which can directly alter surgical therapy.
本研究报告了术中血管内镜的发展情况、所获信息的价值以及该操作中遇到的问题。使用了8台直径为1.5至2.8毫米的血管内镜，其在5毫米处的线分辨率大于0.4毫米。对46例患者进行了110次血管内镜检查；其中24次在外周血管搭桥手术中进行，22次在冠状动脉搭桥手术中进行。这些检查涉及68条动脉、28处新吻合口、6条旧移植物、5次激光血管成形术以及3条原位静脉移植物。最重要的发现是血管内镜数据提供了探头或血管造影无法获得的信息。血管内镜检查结果导致12例患者（26%）的手术操作发生改变，包括3次吻合口修复、3次移植物位置调整以及2次重复血栓切除术。最显著的技术问题是缺乏可操控性和冲洗不足，这导致血管造影图像质量不佳。在术中血管内镜常规应用之前，还需要进一步的技术发展。然而，如果这些问题得到解决，血管内镜将提供独特的高分辨率信息，可直接改变手术治疗方案。
