双人操作水平褥式缝合法在血管缝合中的应用

目的在管壁薄和管径小的血管吻合中,尤其是吻合端口径不一致或端侧吻合中,管壁内翻是微血管外科中导致术后血栓形成、血管危象的常见原因。本文用双人操作水平褥式缝合法避免管壁内翻的同时降低手术操作难度,减少手术时间。方法 A组10指38个吻合口行传统二定点间断缝合,B组10指42个吻合口采用双人操作水平褥式缝合法行单线双针吻合,即每针均由术者自右至左进针然后交由助手由其继续顺行进针完成水平褥式缝合,打结,保证管壁外翻。比较两组吻合口通畅率和吻合时间。结果 A组有2例出现血管危象,经过血管探查重新吻合成功,平均吻合时间为15min;B组吻合口的通畅率为100%,再植指体均成活,平均吻合时间为10min,较传统方法缩短5min。结论该方法避免了吻合血管管壁内翻可能性,尤其对血管吻合端口径不一致或端侧吻合有重要价值,其临床应用是完全可行的。

Objective The goal thin and the caliber small blood vessel tallies in the pipe wall,tallies in particular the end caliber inconsistent or the end side tallies,after in the pipe wall turns is in the capillaries surgical department causes the technique the thrombus to form,the blood vessel crisis common reason.This article sutures the law with the two person operational level mattress type to avoid at the same time which in the pipe wall turns reducing the surgery to operate the difficulty,reduces the surgery time.Methods A groups of 10 figure of 38 lips heal the good traditional two fixed points to suture interrupted,B group of 10 figure of 42 lips heal sutures the law single track with the two person operational level mattress type cross-pointing to tally the law,namely each needle from right after left enters the needle by the technique to give the assistant to continue by it along to march forward the needle to complete the horizontal mattress type to suture,ties a knot,guarantees the pipe wall eversion.Compared with two group of lips heals unobstructed rate and tallying time.Results A group has 2 examples to appear the blood vessel crisis,tallies after the blood vessel investigation successfully,the tallying time is equally 15 min;B group of lips heal unobstructed rate is 100%,again plants refers to the body to survive,the tallying time is equally 10 min,compares the traditional method to reduce 5min.Conclusion This method avoided tallying in the blood vessel pipe wall to turn the possibility,tallied especially to the blood vessel the end caliber inconsistent or the end side tallies has the important value,its clinical practice was completely feasible.