血管吻合器在游离组织瓣修复颌面缺损中的应用

胡广伟 王鸿 王涛

[摘要]目的：探讨血管吻合器在游离组织瓣移植修复口腔颌面部缺损中的应用效果。方法：34例游离组织瓣修复口腔颌面缺损患者，静脉采用血管吻合器行端端吻合，动脉采用手工端端吻合，另选取30例同期手工吻合血管作为对照组，比较两组病例的静脉吻合手术时间、术后并发症及皮瓣成活率。结果：应用血管吻合器行单根静脉吻合平均用时（5.8±1.8）min，明显低于手工吻合平均用时（13.2±2.2）min；两组均无血栓形成，对照组静脉危象发生率为6.67%，与研究组相比无显著性差异。结论：血管吻合器在游离组织瓣修复颌面部缺损中应用，静脉吻合操作簡单、快捷，吻合质量可靠，有较高的临床应用价值。

[关键词]血管吻合器；颌面部；游离组织瓣；静脉吻合；血管危象

[中图分类号]R782.2 [文献标志码]A [文章编号]1008-6455（2018）06-0119-03

Abstract： Objective To study the application effects of vascular anastomotic device for free tissue flap transfer in patients with oral and maxillofacial defects. Methods 34 patients with oral and maxillofacial defects which needing free tissue flaps were selected. Their veins were anastomosed by vascular anastomotic device， arteries were anastomosed by handwork technique end to end. Other 30 cases whose veins were anastomosed by handwork technique were selected as control.The statistical data of the time of veins anastomosis，complications and the rate of flaps salvage were compared. Results The average time of venous anastomosis was（5.8±1.8） min，which was lower than manual anastomosis （13.2±2.2） min significantly. 34 flaps in the experimental group were all survived without occurring vascular crisis， while 2 flaps in the control group had venous crisis（6.67%）. There was no significant different statistically. Conclusion Vascular anastomotic device in vein anastomosis operation for free tissue flap transfer in patients with oral and maxillofacial defects is simple， fast， consistent with reliable quality and high clinical application value.

Key words： vascular anastomotic device； oromaxillo-facial region； free tissue flap； vein anastomosis； vascular crisis

近年来，游离组织瓣移植已经取代了传统带蒂皮瓣和肌皮瓣移植，成为口腔颌面部软组织、骨组织缺损修复与重建的首选[1-2]。传统的显微手工血管吻合易对血管壁造成机械损伤，尤其是对血管内膜的损伤，是导致吻合失败的一个重要原因[3]。另外，显微镜下手法显微吻合操作相对繁琐，吻合时间过长，操作要求较高，需要经过一段时间的严格培训，方能胜任[4]。不少学者及临床医师一直在探索、寻求更为理想的显微血管吻合方法，国外应用微血管吻合器已20余年[5]，而国内报道相对较少。自2015年3月以来，笔者科室将血管吻合器应用于游离组织瓣血管的吻合，效果良好，现报道如下。……