微血管吻合器在口径不等血管吻合中的应用

摘要

目的 探讨微血管吻合器在口径不等血管吻合中的应用方法与效果. 方法 2013年2月至6月,施行游离皮瓣移植的5例患者应用微血管吻合器吻合12条血管,其中6个吻合口供、受区血管口径差异明显,对口径较小的血管行侧方切开或利用“Y”形分支作切开成形,扩大吻合口的周径,选用与较大血管口径匹配的吻合器行血管吻合,术后按微血管吻合处理常规治疗. 结果 应用微血管吻合器行口径不等血管吻合6处,动脉吻合口2个,静脉吻合口4个,一侧管径0.8 ～1.5 mm,另一侧管径2.0 ～3.5 mm,吻合口两端血管口径比例1.0∶1.5～1.0∶3.0,微血管吻合器直径2.0～3.5 mm,口径较小的血管经成形处理后均能顺利外翻固定于较大规格的吻合器挂针上,全部血管吻合均一次成功,耗时3 ～5 min,无血管脱落、漏血,术后未发生血管危象,术后随访1～3个月,皮瓣成活良好. 结论 施行口径不等的微血管吻合时,对口径较小的血管行切开成形,采用较大规格的微血管吻合器吻合血管,可扩大吻合口口径,操作简便、快捷,效果良好.%Objective To investigate the methods and efficacy of anastomosis between vessels with different diameterby using microvascular anastomotic device.Methods From February 2013 to June 2013,5 patients underwent five free-flap transfered with the use of the microvascular anastomotic device in 12 vessels anastomosis,which included 6 anastomosis with different luminal diameter between donor and recipient vessels.We performed vasoplasity via lateral incision or on the Y-shape branch of small-diameter vessels to enlarge the diameter of anastomotic stoma,then microvascular anastomosis device matched the larger-diameter vessel were used in the anastomosis.Conventional therapy of microvascular anastomosis was performed postoperatively.Results Six anastomoses (4 venous,2 arterial) were performed with the microvascular anastomotic device in anastomotic stoma with different luminal diameter between donor and recipient vessels,with diameter (0.8-1.5)mm in one side and 2.0-3.5 mm in the other side,which had ratio from 1.0 ∶ 1.5-1.0∶ 3.0.The end of small-diameter vessel could be everted over the pins of larger microvascular anastomosis device successfully via vasoplasity.The 2.0-3.5 mm microvascular anastomotic device implant was used in these cases.These anastomoses were successfully completed with microvascular anastomotic device without vessel shedding,blood leak intraoperatively and without vascular crisis postoperatively.The time taken to complete an end-to-end anastomosis with microvascular anastomotic device varied from 3-5 min.The followed-up time ranged from 1-3 months,and flap survival in the 5 patients was 100％.Conclusion It is a simple,fast and effective method to perform microvascular anastomosis using microvascular anastomotic device in anastomotic stoma with different luminal diameter through vasoplasity.