血管吻合器在游离皮瓣修复口腔颌面部缺损中的应用

The application of microvascular anastomotic device for free flap transfer in reconstruction of oral and maxillofacial defects

目的 ：探讨血管吻合器在口腔颌面部游离皮瓣血管吻合中的应用效果。方法 ：2014年9月—2015年5月,对21例患者行口腔颌面部组织缺损游离皮瓣修复创面,供血动脉选用面动脉及甲状腺上动脉,回流静脉选用颈外静脉及颈内静脉分支。手工吻合游离皮瓣动脉18条,吻合器吻合游离皮瓣动脉3条、静脉21条;其中头静脉13条,腓动脉伴行静脉6条,股前外侧动脉伴行静脉2条,观察其吻合时间及吻合血管通畅率。采用SPSS l7.0软件包进行统计学分析。结果：吻合后勒血试验证实,动脉和静脉血流通畅率100%。动脉吻合中,供血动脉选用面动脉16次,甲状腺上动脉5次;回流静脉选用静外静脉13次,颈内静脉分支8次。手工吻合动脉平均时间为（17.20±2.31）min,吻合器动脉吻合平均时间为（5.48±1.33）min;手工吻合静脉平均时间为（18.39±3.48）min,吻合器吻合静脉平均时间为（6.45±0.60）min。术后随访游离皮瓣全部成活,缺损修复后皮瓣颜色、形态及质地良好,未出现皮瓣危象及皮瓣坏死。术后血管彩超均显示吻合后动脉吻合口血流通畅,无血栓形成。术后1～3个月复诊,均未见皮瓣坏死。结论：应用血管吻合器吻合静脉速度快,通畅率高,初步结果证明该血管吻合器安全、有效,在一定程度上可节约手术时间。

PURPOSE： To evaluate the clinical effect and summarize the experience of vein anastomosis by microvascular anastomotic device in reconstruction of oral and maxillofacial defects. METHODS： From September 2014 to May 2015,twenty-one free flaps were used to repair oral and maxillofacial defects. During surgery, facial artery or supra thyroid artery were selected as feeding arteries, and external jugular vein or the branch of jugular vein was used as the recipient vein. Eighteen arteries of the free flap were anastomosed by hand, 3 arteries and 21 veins were anastomosed by microvascular anastomotic device. The time of anastomosis and patency of vessels were recorded. Statistical analysis was performed using SPSS l7.0 software package. RESULTS： There was no flap necrosis due to venous thrombosis in this series.The facial artery was used as feeding artery 16 times, supra thyroid artery was used 5 times. The external jugular vein was used as reflux vein 13 times, the branch of jugular vein was used 8 times. The duration of artery anastomosis were17.20±2.31 minutes by hand and 5.48 ±1.33 minutes by microvascular anastomotic device. The duration of vein anastomosis were 18.39 ±3.48 minutes by hand and 6.45 ±0.60 minutes by microvascular anastomotic device. CONCLUSIONS：Application of microvascular anastomotic device can significantly improve the anastomotic speed and vein flow rate. The preliminary results show that blood vessel anastomosis by device is effective and safe.