Heijmen R H, Gründeman P F, Borst C
Department of Cardiology, Utrecht University Hospital, The Netherlands.
Ann Thorac Surg. 1998 Mar;65(3):705-11. doi: 10.1016/s0003-4975(97)01310-6.
To prevent ischemic complications during coronary bypass grafting on the beating heart, a nonocclusive distal anastomosis technique is needed. One recently developed nonocclusive technique requires apposition of the intima of the graft to the adventitia of the recipient artery, in contrast to current surgical practice, which dictates apposition of both intimas.
To compare the sole effect of intima-adventitia apposition (n = 18) versus traditional intima-intima apposition (n = 18), we investigated radiolabeled platelet deposition and histomorphologic aspects of vascular wall healing quantitatively in a porcine carotid artery bypass graft model. Both groups were evaluated at 2 hours, 2 days, or 4 weeks.
Within the first 2 hours, 3 of 6 pigs with intima-adventitia apposition exhibited cyclic flow reductions as a result of massive mural thrombosis. After intima-adventitia apposition, the number of deposited platelets was significantly higher compared with intima-intima apposition, 147.1 +/- 73.0 x 10(6) and 4.6 +/- 1.0 x 10(6) platelets/cm2 (mean +/- standard error of the mean), respectively (p = 0.03). At 2 days, the suture line was covered with small mural thrombi, whereas no thrombi were found after intima-intima apposition. At 4 weeks, intimal hyperplasia at heel and toe was not significantly different from that with intima-intima apposition.
Despite thrombotic phenomena in the early phase, intima-adventitia apposition yielded a patent anastomosis with a small intimal hyperplasia response.
为预防心脏不停跳冠状动脉搭桥术中的缺血性并发症，需要一种非闭塞性远端吻合技术。最近开发的一种非闭塞技术要求移植血管内膜与受体动脉外膜贴合，这与当前要求两内膜贴合的手术操作不同。
为比较内膜-外膜贴合（n = 18）与传统内膜-内膜贴合（n = 18）的单独效果，我们在猪颈动脉搭桥模型中定量研究了放射性标记血小板沉积和血管壁愈合的组织形态学方面。两组分别在2小时、2天或4周时进行评估。
在最初2小时内，6只采用内膜-外膜贴合的猪中有3只因大量壁内血栓形成而出现周期性血流减少。内膜-外膜贴合后，沉积的血小板数量显著高于内膜-内膜贴合，分别为147.1±73.0×10(6)和4.6±1.0×10(6)个血小板/cm2（平均值±平均标准误差）（p = 0.03）。在2天时，缝线处覆盖有小的壁内血栓，而内膜-内膜贴合后未发现血栓。在4周时，足跟和趾部的内膜增生与内膜-内膜贴合相比无显著差异。
尽管早期有血栓形成现象，但内膜-外膜贴合产生了通畅的吻合口，内膜增生反应较小。
