冠脉搭桥手术前大隐静脉和胸廓内动脉移植血管内膜增生的形态学研究

The Morphometric Analysis of Intimal Hyperplasia in Saphenous Veins and Internal Thoracic Arteries before Coronary Artery Bypass Grafting

目的研究冠脉搭桥手术采用的动静脉移植血管手术前内膜增生(IH)的发生情况,避免在搭桥手术中使用有病变的移植血管而导致手术失败。方法从50例搭桥患者中取46段大隐静脉(SV)和27段胸廓内动脉(ITA),其中20位患者有20段配对的SV和ITA,采用形态学分析方法,分析SV和ITA移植血管手术前内膜增生发生率,测量移植血管内膜和中膜厚度及面积,比较内膜增生指数。结果SV移植血管内膜增生发生率显著高于ITA。SV内膜面积、中膜面积、内膜厚度以及中膜厚度均显著大于ITA移植血管。有内膜增生的SV和ITA的内膜厚度指数(ITI)、内膜/中膜比(IMR)均显著大于无内膜增生的SV和ITA。结论ITI和IMR是对移植血管内膜增生程度进行分级的敏感方法。手术前对准备采用的移植血管进行精确的筛选,将能有效地预防手术后移植血管内膜增生的发生,有助于提高移植血管的长期通畅率。

Objective To study the pre-existing intimal hyperplasia （IH） in saphenous veins （SV） and internal thoracic arteries （ITA） before coronary artery bypass grafting （CABG）, to avoid the use of diseased graft vessels, and prevent the failure of the surgery. Methods Forty-slx segments of SV and 27 of ITA were collected from 50 patients before undergoing CABG. Morphometric analysis was performed to study the occurrence rate of the IH in vein and artery vessels. The width and area of the intima and media were measured, and IH indexes were also compared. Results The occurrence rate of IH was significantly higher in SV than in ITA. Intimal thickness index （ITI） and intima-to-media ratio （IMR） were significantly higher in vein and artery vessels with IH than in the vessels without IH. Conclusion The IH indexes （ITI, IMR） are very sensitive tools to grade the degree of IH in the graft vessels. The carefully screening the graft vein and artery vessels before the operation can effectively prevent the occurrence of the graft vessel disease after surgery, and help to increase the patency rate of the grafted vessels.