微血管无缝线吻合技术的研究进展和应用前景

Research progress of sutureless microvascular anastomosis

血管损伤尤其是微血管损伤是外科创伤中常见的类型,血管吻合是创伤外科中重要的操作技术,在器官移植、创伤修复和肢体再植等领域具有广泛的应用。缝线吻合是血管吻合操作的金标准,但吻合直径<3 mm的微血管对外科医师经验和技术依赖性较强,同时血管缝线吻合本身可能引入新的创伤,在微血管吻合中该损伤更为显著。为降低操作难度,缩短手术时间,避免额外的内膜损伤,无缝线血管吻合技术作为缝线血管吻合的补充技术被逐步开发并应用于微血管吻合。本文综述了粘合吻合、激光辅助吻合、血管内支架辅助吻合、血管吻合器四个技术中应用于微血管的研究,探讨不同无缝线吻合技术在针对微血管吻合时的优劣,旨在为临床应用提供参考,并对未来的研究方向进行展望。

Vascular injury,particularly microvascular injury,is a common type of surgical trauma.Vascular anastomosis is a crucial technique in organ transplantation,trauma repair,and limb replantation with wide applications.Suture anastomosis is considered the golden standard for vascular anastomosis procedures,but its outcome mainly relies on the skills and experiences of the surgeon in dealing with microvessels with a diameter<3 mm.Additionally,suture anastomosis may cause additional trauma to vessels,especially for microvessels,for which the damage is more significant.To alleviate procedural challenges,reduce operation time,and avoid extra intimal damage caused by sutures,sutureless vascular anastomosis techniques have been developed as a supplementary method to suture anastomosis and gradually applied for microvascular anastomosis.This article presents a comprehensive review of four primary techniques employed in microvascular anastomosis:adhesive anastomosis,laser-assisted anastomosis,intravascular stent-assisted anastomosis,and vascular coupler anastomosis.The advantages and disadvantages of different sutureless vascular anastomosis techniques for microvessels are discussed to provide clinical references and offer insights into future research directions.