內乳動脈擷取的創新技術：系統綜述

Innovations of Internal Mammary Artery Harvest: A Systematic Review

在傳統的開放式、胸腔鏡和機器人冠狀動脈繞道手術下，通過諧波刀擷取內乳動脈（IMA）的效果尚未得到詳盡的評估。本研究之素材基於1998年至2018年間發表的相關文章的文獻檢索。共有20篇文章描述2,661名患者IMA之擷取是在開放式、視頻輔助或機器人冠脈繞道手術中使用諧波手術刀完成擷取的（稱為創新組），而採用電刀和（或）氬束凝固器進行IMA擷取者則作為對照組。結果表明，採用諧波刀擷取IMA可減少熱損傷，並有可能更好地保護內皮細胞，術中IMA流量滿意，術後IMA通暢性佳。除了擷取技術的相關優點之外，創新技術在臨床結果方面還具有其他優勢，如較低的術後死亡率和併發症。然而，考慮到胸腔鏡和機器人IMA擷取的缺點，諸如取材花費時間較長、手術時間延長和住院費用增加，它們可用於選擇性和非緊急的冠心病患者。

The effects of internal mammary artery (IMA) harvest by harmonic scalpel under conventional open, thorascopic, and robotic coronary artery bypass have not been sufficiently evaluated. The study materials were based on literature retrieval of pertinent articles published between 1998 and 2018. In total 20 articles describing IMA harvests for 2,661 patients were accomplished by the harmonic scalpel in open, video-assisted, or robotic coronary artery bypass grafting (CABG) procedures (termed as the innovation group), while IMA harvest by electrocautery and (or) argon beam coagulator were taken as the control group. IMA harvest by harmonic scalpel was associated with less thermal injury with potentially better preservation of the endothelial cells, satisfactory intraoperative IMA flow and promising postoperative IMA patency. Apart from the harvest-related merits, the innovative techniques had other advantages in terms of clinical outcomes, such as lower postoperative mortality and complications. Nevertheless, concerning the disadvantages of thorascopic and robotic IMA harvesting, such as longer harvest time, prolonged operative time and increased hospitalization expenses, they could be used in selected and non-emergent patients with coronary artery disease.