等距对称分叶法吻合小血管的实验及临床应用研究

CLINICAL APPLICATION AND EXPERIMENT STUDIES ON VASCULAR ANASTOMOSIS WITH LOBULATED END SINISOMETVIC AND SYMMETRY

目的：吻合口管壁等距对称分叶后吻合小血管，确保吻合口管壁完全外翻；内膜平整对合，降低血管危象的发生率，提高通畅率。方法：将吻合口管壁纵形剪开分叶，剪开的深度为管壁厚的２倍，小血管分３叶者吻合６针，４叶者８针。用二定点法先缝合叶部，后缝合２叶之间。用此法共吻合大白鼠尾动脉１００个吻合口，免股动脉和肱动脉１２０个吻合口，免耳皮瓣自体交叉移植２０个，用此法进行断手指再植１５例，游离皮瓣移植５例。结果：１００个大白鼠尾动脉吻合后即刻通畅率为１００％，１２０个股、肱动脉吻合后３周其通畅率为９７．５％（３个吻合口因伤口感染栓塞），吻合前、吻合后３周时吻合口内径经ｔ检查无显著差异（Ｐ＞０．０５），兔耳皮瓣全部成活，临床应用２０例全部成功。未发生血管危象。吻合口经扫描电镜观察，愈合过程优于端端吻合法。结论：此法吻合微小血管能确保其吻合口管壁外翻，内膜平整对合，减少缝合针数。有利于吻合口的无创操作，使血管的通畅率提高。

Objective:In order to ensure the vessel wall everting suture,decrease the vessel crisis after microvascular anastomosis.Method:According to diameter,we excised the vascular wall longitudinally to flaps,3 flaps,with 6 stitches or 4 flaps with 8 stitches. We suture the flaps with the edge distance 2 or 3 milimetre and thickness of vessel wall,after that suture between two flaps,the edge distance is thickness of vessel wall.With this methld,we sutured 100 tail arterial of wister rats and 120 rabbits. Artery of the four limbs and 20 rabbits ear plap were transplated.We have 15 finger replantation and 5 free flaps transplatation. Results:100 rats tail artery and 120 limbs artery of rabbit limb unobstructed at once after anastomosis.117 artery of rabbit limbs were unobstructed after 3 weeks of anastomosis,3 were embolism because infection.The internal diameter of anastomosis edge of rabbit femoral and humeral before and after anastomosis three weeks are not stenosis ( P >0 05).20 rabbits ear flaps and 20 cases of finger replantation and free plap received good results.These did not occurre the vascular crisis. Conclusions:We found the healing process of anastomosis edge is superior to other method under scanning electronic microscope.It increased the unobstructed rate.