微血管吻合器在游离皮瓣修复头颈部肿瘤性缺损中的初步应用

The preliminary application of microvascular anastomotic device for free flap transfer in head and neck cancer patients with locally advanced lesion

目的观察头颈部肿瘤切除后缺损行修复重建手术中应用微血管吻合器吻合静脉的效果。方法共收治头颈部恶性肿瘤需行游离皮瓣局部修复的晚期患者16例，应用吻合器术中吻合静脉系统，选取1年内的40例同期手法吻合血管为对照，统计静脉吻合用时、血栓形成和最终皮瓣挽救率进行比较。结果应用吻合器行静脉吻合平均用时（6．31±0．87）rain，明显低于手工吻合平均用时（19．20±4．62）min；无血栓形成，与致均可缝合血栓率5％（2／40）无明显差别；吻合器吻合患者1例静脉成角，回流不畅，皮瓣挽救成功，与对照组皮瓣成活率97．5％（39／40）无明显差别。结论微血管吻合器适用于静脉吻合，明显缩短了手术时间，血栓发生率和皮瓣成活与常规吻合没有差别；能够有效防止血管痉挛和血栓形成并发症的发生，MRI检查安全，可以有效替代缝合线手工缝合而有望成为微静脉端端吻合最常用的选择。

Objective To observe the effect of vein anastomosis by microvaseular anastomotic device in head and neck reconstruction. Methods Sixteen cases needing free flaps were randomly selected in head and neck cancer patients with locally advanced lesion. Their veins were anastomosed by microvascular anastomotic device. Other 40 cases whose veins were anastomosed by manual anastomosis were selected as control during the same year. The statistical data of the time of veins anastomosis, thrombosis and the rate of flaps salvage were compared. Results The average time of venous anastomosis was 6. 31 ＋ 0. 87 minutes, which was lower than the manual anastomosis （19. 20 ＋-4. 62 minutes） significantly. There was no thrombosis, which was not significant different with the manual anastomosis. One case＇s venous blood flow was not smooth for the angled vein and the flap salvage operation was successful. Conclusion The time of venous anastomosis is shorten significantly by microvascular anastomotic device. The incidence of thrombosis is the same compared with venous anastomoses performed with sutures. The microvascular anastomotic device system allowed a time-efficient and safe venous anastomosis.