Santoli E, Di Mattia D, Boldorini R, Mingoli A, Tosoni A, Santoli C
Department of Thoracic and Cardiovascular Surgery, L. Sacco Hospital, Milan, Italy.
Eur J Cardiothorac Surg. 1993;7(10):548-52. doi: 10.1016/1010-7940(93)90055-g.
Endothelial damage of human saphenous vein (HSV) during the preparation for bypass grafting could affect graft patency. Improving the preservation of HSV could provide a longer and better patency of coronary artery bypass grafts. An electron microscopic comparative analysis of the effects of three different preservatives on HSV morphology was carried on in order to determine the best method to prevent or minimize possible endothelial damage. Distal segments of HSVs were harvested from 15 patients with a "no-touch" technique. Each segment was divided into seven specimens after a low pressure distension with saline solution. The first of them was fixed immediately after harvesting with 2.5% glutaraldehyde solution, for basal evaluation. Three were fixed after 30 min and three after 5 h preservation at 4 degrees C in a) autologous, oxygenated, and heparinized blood (AOHB), b) heparinized saline solution with papaverine (HSSP) and c) University of Wisconsin solution (UWS). The specimens preserved in AOHB showed marked endothelial cell detachment and endothelial cell loss after both preservation times (30 min and 5 h). The specimens preserved in HSSP for 30 min showed no alteration in endothelium in 12 cases, while a partial endothelial detachment with intracellular edema was present in the last 3 cases; all 5 h specimens showed only a few remnants of endothelial cells. The specimens preserved in UWS for 30 min showed a morphology comparable to specimens preserved in the saline solution for the same time; in the 5 h specimens a well preserved endothelium was found in 11 cases and partial endothelial detachment and subendothelial edema in the other 4.(ABSTRACT TRUNCATED AT 250 WORDS)
在旁路移植术准备过程中,人隐静脉(HSV)的内皮损伤可能会影响移植血管的通畅性。改善HSV的保存方法可以使冠状动脉旁路移植术的通畅时间更长且效果更好。为了确定预防或最小化可能的内皮损伤的最佳方法,对三种不同防腐剂对HSV形态的影响进行了电子显微镜对比分析。采用“非接触”技术从15例患者身上获取HSV的远端节段。每个节段用盐溶液低压扩张后分成七个标本。第一个标本在获取后立即用2.5%戊二醛溶液固定,作为基础评估。三个标本在4℃下分别用a)自体、氧合和肝素化血液(AOHB)、b)含罂粟碱的肝素化盐溶液(HSSP)和c)威斯康星大学溶液(UWS)保存30分钟后固定,另外三个标本保存5小时后固定。保存在AOHB中的标本在两个保存时间(30分钟和5小时)后均显示出明显的内皮细胞脱离和内皮细胞丢失。保存在HSSP中30分钟的标本,12例内皮无改变,后3例出现部分内皮脱离伴细胞内水肿;所有保存5小时的标本仅显示少数内皮细胞残余。保存在UWS中30分钟的标本形态与保存在盐溶液中相同时间的标本相似;在保存5小时的标本中,11例内皮保存良好,另外4例出现部分内皮脱离和内皮下水肿。(摘要截取自250字)