微血管吻合器在头颈部缺损修复重建中的应用

Application of microvascular anastomotic device in head and neck reconstruction

目的探讨微血管吻合器在头颈部缺损血管化游离组织瓣修复重建中的应用价值。方法对2013年7月至2013年11月间，12例头颈部肿瘤患者肿瘤切除后组织缺损，同期行血管化游离组织瓣修复重建，术中血管吻合选择应用微血管吻合器，记录术中游离组织瓣类型、选用的供区血管和受区血管类型和口径、微血管吻合器的型号、记录血管吻合时间和吻合成功后即刻吻合口通畅情况，术后严密观察游离组织瓣血供情况，随访游离组织瓣成活情况。结果本组共完成游离组织瓣12例，包括游离腓骨瓣6例，前臂皮瓣4例，股前外侧皮瓣2例，随访3～8个月，结果显示皮瓣全部成活。术中共使用微血管吻合器17只，均为端端吻合，包括单独静脉使用7例，动、静脉同时使用5例。应用微血管吻合器进行血管吻合的时间为4～10min，平均6．8min，吻合结束即刻检查血管通畅率为100％。1例动脉吻合使用微血管吻合器，发现吻合口漏血，更换吻合环再次吻合成功。结论微血管吻合器用于头颈部组织缺损游离组织瓣修复重建，可以大大简化术中操作，保证吻合口通畅，具有临床推广价值。

Objective To describe the clinical application of microvascular anastomotic device in head and neck reconstruction. Methods From July, 2013 to November, 2013, microvaseular free flaps were transferred to reconstruct the defects simuhaneously after tumor resection of head and neck region in 12 cases in Department of Oral and Maxillofaeial Surgery, Peking University School of Stomatology. Microvaseular anastomotie coupling devices （MACD） were used in vascular anastomosis. The clinical data were collected and analyzed, including the selection of free flap, diameter of donor and recipient vessels, type of MACD, time of anastomosis, instant pateney of anastomosis. The flap was monitored closely after operation and the final survival rate was calculated. Results Twelve microvaseular free flaps were done in this series, including 6 fibula flaps, 4 forearm flaps and 2 anterolateral thigh flaps. Totally 17 MACD were used by end-to-end anastomosis in this series, including 5 arterial anastomosis and 12 venous anastomosis. The anastomose time using MACD was from 4 to 10 minutes, with a median time 6. 8 minutes. The instant patency rate of anastomosis was 100%. There were some blood leakages near the anastomotic stoma in 1 arterial anastomosis using MACD. It was resolved successfully by changing a new MACD. Conclusion Our primary clinical experience showed that the MACD was well suited to the mierovascular reconstruction of head and neck defect. The feasibility and reliability was confirmed by our clinical cases. It should be recommended as a safe, fast and reliable adjuvant anastomotie instrument for free tissue transfer.