内乳动脉和桡动脉的临床解剖与组织学研究

Study on clinical anatomy and histological characters of internal mammary artery and radial artery

目的 研究冠状动脉旁路移植术 (CABG)动脉血管材料———内乳动脉 (IMA)、桡动脉 (RA)的临床解剖和组织学特征。方法 采用游标卡尺分别测量CABG患者术中IMA、RA长度及近远端外径各 30例 ;光学显微镜下观察CABG术中收集到的IMA、RA远端片段各 30根。并测量IMA、RA内、中膜各层厚度。采用动脉内膜与中膜厚度之比判断动脉硬化程度并将其分为 0级、Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级。结果 测量IMA平均长度 18.2 5cm(16 .10～ 2 0 .4 0cm) ,外径近端和远端分别为 3.10mm(2 .99～ 3.2 1mm)和 2 .0 3mm(1.90～ 2 .16mm) ;RA平均长度 2 2 .0 6cm(19.5 6～2 2 .5 6cm) ,外径近端和远端分别为 3.2 1mm(3.0 9～ 3.33mm)和 2 .6 0mm(2 .5 0～ 2 .70mm)。IMA与RA之间比较无显著性差异 (P >0 .0 5 )。IMA和RA内、中、外膜三层结构清晰 ,两者的显微结构很为相似。IMA与RA动脉硬化程度之比P >0 .0 5。结论 IMA和RA有足够的长度能满足CABG ,IMA和RA直径与冠状动脉相匹配。IMA和RA均为搏动性的肌性动脉血管 ,解剖与组织学比较相差无显著性。均为较理想的动脉移植材料。

Objective To study the clinical anatomic and histological characters of internal mammary artery(IMA) and radial artery(RA) which were often used in coronary artery bypass graft(CABG) procedure.Methods During CABG,the lengths, the proximal and distal external diameter of RA and IMA were measured with vernier caliper respectively in 30 cases. The intima and meddle layer of 30 IMA and RA were observed and measured with microscope. The thickness ratio of intima and meddle layer was utilized to estimate arterial atherosclerotic degree in 5 levels 0, I, II, III and IV.Results The mean length, proximal and distal external diameter of IMA were 18.25 cm(16.10～20.40 cm), 3.10 mm(2.99～3.21 mm) and 2.03 mm(1.90～2.16 mm). The mean length, proximal and distal external diameter of RA were 22.06 mm(19.56～22.56 mm), 3.21 mm(3.09～3.33 mm) and 2.60 mm(2.50～2.70 mm) respectively.There was no significant difference between IMA and RA(P>0.05) as the graft conduit. The ultrastructure of intima,meddle layer and external membrane of IMA and RA are clear and similar. There was no significant difference between IMA and RA(P>0.05) in the atherosclerotic degree.Conclusion The length of IMA and RA are enough to act as the vessel conduit of the CABG . Both of IMA and RA are pulsatile and muscular medial artery, and their diameters are similar to the coronary artery. There is no significant difference between IMA and RA in clinical anatomic and histological characters.