[动脉移植物与静脉移植物的形态学比较]

[Morphological comparison between arterial grafts and venous grafts].

作者信息

Sueda T, Shikata H, Orihashi K, Kanehiro K, Kawaue Y, Matsuura Y

机构信息

First Department of Surgery, Hiroshima University, School of Medicine, Japan.

出版信息

Nihon Kyobu Geka Gakkai Zasshi. 1994 Sep;42(9):1315-9.

PMID:7989790

Abstract

We have extendedly used arterial grafts in coronary bypass surgery because of their better patency rate. We have operated 134 cases of coronary bypass during recent 27 months. Postoperative angiography showed high patency rate in arterial grafts, such as 97% (59/61) of right internal thoracic artery (RITA), 98% (107/109) of left internal thoracic artery (LITA), 96% (83/86) of right gastroepiploic artery (RGEA), comparing with 86% (26/30) of saphenous vein graft (SVG). Pathological examination was done by specimens of grafts obtained during operation. Vasa vasorum was poorly developed in ITA and RGEA. ITA had several layers of elastic fiber in media and RGEA had smooth muscular media. Both arterial grafts showed low atherosclerotic scores (intima/media), 7.1% in RITA, 7.3% in LITA and 6.8% in RGEA. But some cases with hyperlipidemia and/or diabetes showed high score of atherosclerosis in arterial grafts. Endothelial cells were well preserved in both arterial grafts after harvesting, in contrast with poor endothelial preservation in SVG. Endothelial appearance of RGEA was similar to that of the coronary artery and different from that of ITA. RGEA is superior grafts for CABG as coronary bypass because of their structural superiority.

摘要

由于动脉移植物具有更高的通畅率，我们在冠状动脉搭桥手术中广泛使用了动脉移植物。在最近27个月里，我们共进行了134例冠状动脉搭桥手术。术后血管造影显示动脉移植物的通畅率很高，如右胸廓内动脉（RITA）为97%（59/61），左胸廓内动脉（LITA）为98%（107/109），右胃网膜动脉（RGEA）为96%（83/86），而大隐静脉移植物（SVG）的通畅率为86%（26/30）。通过手术中获取的移植物标本进行病理检查。胸廓内动脉和右胃网膜动脉的滋养血管发育不良。胸廓内动脉中膜有几层弹性纤维，右胃网膜动脉中膜为平滑肌。两种动脉移植物的动脉粥样硬化评分（内膜/中膜）都很低，右胸廓内动脉为7.1%，左胸廓内动脉为7.3%，右胃网膜动脉为6.8%。但一些高脂血症和/或糖尿病患者的动脉移植物动脉粥样硬化评分较高。与大隐静脉移植物内皮保存不佳相比，两种动脉移植物在获取后内皮细胞保存良好。右胃网膜动脉的内皮外观与冠状动脉相似，与胸廓内动脉不同。由于其结构优势，右胃网膜动脉是冠状动脉搭桥手术中理想的移植物。