微血管吻合器在头颈缺损修复吻合动脉和静脉中的应用

Arterial and venous coupling by microvascular anastomotic coupling device in head and neck reconstruction

目的：探讨微血管吻合器在头颈外科修复重建血管（尤其动脉）吻合中的应用价值，并总结经验，提升皮瓣移植手术成功率。方法收集从2015年1月至2016年8月在我科行游离皮瓣修复重建手术患者的相关资料，包括游离皮瓣类型、选用的供区及受区血管、血管缝合方法、应用微血管吻合器型号、血管吻合时间、术后皮瓣成活情况等。结果共有169例患者被纳入，其中25例为手工缝合显微血管，144例使用了微血管吻合器吻合血管。吻合器组动脉、静脉吻合的耗时分别为（5．7±1．2）min和（5．1±1．0）min，均少于手工组[动脉、静脉吻合的耗时分别为（21．4±3．1）min和（23．2±4．2）min]；本研究共使用了223个微血管吻合器分别吻合44条动脉和179条静脉。统计分析比较微血管吻合器吻合和手工缝合动、静脉对游离皮瓣血管危象发生率和坏死率差异无统计学意义（P〉0．05）；使用微血管吻合器吻合动脉的患者中出现1例动脉性血管危象（2．3％），但无皮瓣坏死。结论微血管吻合器是头颈部组织缺损游离皮瓣瓣修复重建静脉吻合的理想选择，成功率高，可明显缩短手术时间。在合理的血管选择及预处理后微血管吻合器可成为显微动脉吻合的一个重要选择。

Objective To assess the value of using microvascular anastomotic coupling device （MACD） in head and neck reconstruction, especially in arterial coupling. Our experience was summed up to improve the success rate of anastomosis. Methods This research had enrolled all patients performed free flap reconstruction in our de-partment from January, 2015 to Auguest, 2016. The data were obtained on type of free flap, donor and recipient ves-sels, type of MACD, time of anastomosis and so on. Results 169 patients were included in this study. Free flap re-constructions were done by manual suture in 25 patients and MACD in 144 patients. Coupling the arteries and veins by MACD[（5.7 ± 1.2）min and （5.1 ± 1.0） min, respectively] had taken less time than manual suture[（21.4 ± 3.1）min and （23.2 ± 4.2）min, respectively]. 223 MACD were used totally to couple 44 arteries and 179 veins. There was no significant statistical difference in vascular crisis and flap survival between manual suture and MACD（P 〉 0.05）. One arterial crisis （2.3%） and on flap loss was found in the patients coupling arteries by MACD. Conclusion MACD is a optimal method for coupling veins of free flap in head and neck reconstruction, because of high success rate and shortening surgery time. As well MACD can be a important option in arterial anastomosis after appropriate vessels choosing and pretreatments.