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在桡动脉获取过程中，锐性解剖、电灼和超声刀在血管内皮损伤、准备时间及术后出血方面的比较

Comparison of Sharp Dissection, Electrocautery, and Ultrasonic Activated Scalpel with Regard to Endothelial Damage, Preparation Time, and Postoperative Bleeding During Radial Artery Harvesting.

作者信息

Uysal Dinçer, Gülmen Şenol, Özkan Hayrettin, Sağlam Ulaş, Etli Mustafa, Bircan Sema, Sütçü Recep, Yavuz Turhan, Öntaş Hakan, Aksoy Fatih

机构信息

Suleyman Demirel University School of Medicine Department of Cardiovascular Surgery Isparta Turkey Department of Cardiovascular Surgery, Suleyman Demirel University, School of Medicine, Isparta, Turkey.

Suleyman Demirel University School of Medicine Department of Pathology Isparta Turkey Department of Pathology, Suleyman Demirel University, School of Medicine, Isparta, Turkey.

出版信息

Braz J Cardiovasc Surg. 2019 Dec 1;34(6):667-673. doi: 10.21470/1678-9741-2018-0311.

DOI:10.21470/1678-9741-2018-0311
PMID:31364343
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6894033/
Abstract

OBJECTIVE

To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG).

METHODS

Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared.

RESULTS

Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group.

CONCLUSION

Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.

摘要

目的

探讨经典技术、电灼术和超声解剖对冠状动脉旁路移植术（CABG）期间桡动脉（RA）内皮完整性、功能及获取准备时间的影响。

方法

对45例行单纯CABG且RA适合使用的患者进行研究，并分为三组：第1组，经典方法（使用锐性解剖）；第2组，电灼术；第3组，超声电灼术。通过生化方法检测前列环素和一氧化氮衍生物水平；采用免疫组织化学染色评估血管细胞黏附分子1（VCAM-1）和内皮型一氧化氮合酶（eNOS）值。比较RA准备时间、RA长度/获取时间比值以及RA切除部位的引流量。

结果

各组间RA准备时间（第1组：25±6分钟，第2组：18±3分钟，第3组：16±3分钟，P<0.001）和长度/获取时间比值（第1组：0.76±0.19厘米/分钟，第2组：0.98±0.16厘米/分钟，第3组：1.13±0.09厘米/分钟，P<0.001）差异具有统计学意义。前列环素和一氧化氮衍生物水平差异无统计学意义，各组间VCAM-1和eNOS表达相似，且每组仅1例患者检测到内皮损伤。

结论

RA准备期间使用超声电灼术可显著缩短准备时间并减少术后引流量。然而，考虑到生化和组织病理学评估均显示存在内皮损伤时，无法证明一种方法优于其他方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/0b05a18f644f/rbccv-34-06-0667-g06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/b47e1c70c6b6/rbccv-34-06-0667-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/742b21eb1e8d/rbccv-34-06-0667-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/49c8c75aadc8/rbccv-34-06-0667-g03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/5b31a033e2f1/rbccv-34-06-0667-g04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/f3c58da8f143/rbccv-34-06-0667-g05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/0b05a18f644f/rbccv-34-06-0667-g06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/b47e1c70c6b6/rbccv-34-06-0667-g01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/742b21eb1e8d/rbccv-34-06-0667-g02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/49c8c75aadc8/rbccv-34-06-0667-g03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/5b31a033e2f1/rbccv-34-06-0667-g04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/f3c58da8f143/rbccv-34-06-0667-g05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6dff/6894033/0b05a18f644f/rbccv-34-06-0667-g06.jpg

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[The morphometry and eNOS expression of radial artery in elderly patients with coronary atherosclerotic heart disease].[老年冠状动脉粥样硬化性心脏病患者桡动脉的形态计量学及内皮型一氧化氮合酶表达]
Zhonghua Wai Ke Za Zhi. 2010 Jun 1;48(11):825-9.
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Harvesting of the radial artery for coronary artery bypass grafting: comparison of ultrasonic harmonic scalpel dissector with the conventional technique.用于冠状动脉旁路移植术的桡动脉采集：超声谐波手术刀解剖器与传统技术的比较。
J Card Surg. 2009 May-Jun;24(3):285-9. doi: 10.1111/j.1540-8191.2008.00788.x. Epub 2009 Mar 2.
3
Harmonic scalpel versus electrocautery for harvest of radial artery conduits: reduced risk of spasm and intimal injury on optical coherence tomography.
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5
Effects of normothermic organ bath and verapamil-nitroglycerin solution alone or in combination on the blood flow of radial artery.常温器官浴及维拉帕米-硝酸甘油溶液单独或联合应用对桡动脉血流的影响
Eur J Cardiothorac Surg. 2007 Oct;32(4):617-22. doi: 10.1016/j.ejcts.2007.06.039. Epub 2007 Aug 20.
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Does radial artery harvest with a harmonic scalpel result in fewer complications than standard electrocautery methods?与标准电灼法相比，使用谐波手术刀获取桡动脉会导致更少的并发症吗？
Interact Cardiovasc Thorac Surg. 2006 Feb;5(1):36-41. doi: 10.1510/icvts.2005.123455. Epub 2005 Nov 17.
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Open clip-free radial artery harvesting with the harmonic shears.使用谐波剪进行无夹子的桡动脉游离取材。
J Card Surg. 2007 Mar-Apr;22(2):139-41. doi: 10.1111/j.1540-8191.2007.00374.x.
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