微血管吻合器在游离组织瓣修复头颈部肿瘤术后缺损中的应用

摘要

Objective To investigate the application and operation skills in vein anastomosis by microvascular anastomotic coupler (MAC) in reconstruction of defects after head and neck cancer resection.Methods From August 2015 to July 2016,in Department of Head and Neck Surgery,Sichuan Cancer Hosipital,17 cases underwent the reconstruction of defects after head and neck cancer resection with free tissue flaps,including forearm flaps in 11 casess,anterolateral flaps in 4 casess and fibula flaps in 2 casess.Totally 17 MAC were used,including 14 MAC for end-to-end anastomosis and 3 MAC for end-to-side anastomosis.SPSS 22.0 software was used to analyze the data.Results Venous anastomoses in 17 free tissue flaps were successfully completed,with no anastomotic errhysis.All flaps survived well.The time required for vascular anastomoses with MAC varied 2-9 min,with average time of (4.2±2.3) min,which was significantly shorter than that with manually anastomosis (17.4 ± 2.7) min (t=15.1,P<0.01).The followed-up time ranged from 6 to 18 months.The flaps in recipient area healed well.The shape and function of recipient area were satisfying.Conclusions Microvascular anastomotic coupler can be used for vessel anastomosis in free tissue flap for reconstruction of defect after head and neck cancer resection,which requires for less operation time and shows good results.%目的 探讨应用微血管吻合器在游离组织瓣修复头颈部缺损中吻合血管的效果和操作技巧.方法 2015年8月至2016年7月四川省肿瘤医院头颈外科应用游离组织瓣修复头颈部肿瘤术后缺损患者17例,其中前臂皮瓣11例、股前外侧穿支皮瓣4例、游离腓骨肌皮瓣2例,使用微血管吻合器17枚用于静脉吻合,其中端端吻合14例,端侧吻合3例.回顾性分析供皮瓣类型、供受区血管选择、吻合方式、吻合器的吻合环的选择、操作时间及技巧、术后皮瓣观察及随访等临床资料.以SPSS 22.0进行统计学分析(t检验).结果 17例游离组织瓣应用吻合器吻合的血管均为静脉,操作一次成功,吻合口无渗血,术后皮瓣全部成活.吻合时间2~9 min,平均吻合时间(4.2±2.3) min,与同期患者动脉手工吻合平均时间为(17.4±2.7)min相比明显缩短,差异有统计学意义(t=15.1,P<0.01).术后随访时间6~18个月,受区皮瓣愈合良好,局部外形及功能满意.结论 微血管吻合器在游离皮瓣修复头颈部缺损中吻合血管操作方便,成功率高,可明显缩短手术时间,有助于提高皮瓣修复的成功率.