组合组织移植的血管处理

Vessel disposal of combined tissue transplantation

目的 探讨组合组织移植的血管吻接方式、方法及血管危象的处理。方法 对 1990年 12月至 2 0 0 1年 12月收治的 2 84例组合组织移植 ( 2、3、4、5块游离组织组合移植 )病史中 ,分析并总结发生血管危象的原因、手术探查血管的发现和处理及最后导致组织坏死的因素。结果 2 84例中血管危象的发生率 ( 3 6例 )为 12 .68% ,手术探查率 ( 3 2例 )为总病例的 11.2 6%。探查术后组织块的存活率 (组织坏死 10例 )占探查总数的 68.75 % ,占总病例数的 3 .5 2 %。探查术中均重接动脉 (直接或静脉移植 ,最多探查 3次 ) ,失败原因为手术探查不及时、手术操作损伤血管、血管搭配不合理。 4例未探查的病例皮瓣均失败占总病例的 1.41%。组织块的总存活率为总数的 95 .0 7%。引起血管危象的主要原因是技术操作不当 ,吻合口栓塞 ,血管压迫、扭曲 ,及血管顽固性痉挛。结论 组合组织移植应选择供、受区合适的供血动脉和回流静脉。 2块以上的组织移植应采取血管 (动静脉 )串联、并联或串并联的吻合方式。一旦发生血管危象应在 48h内作探查术。

Objective To discuss the patterns and methods of blood vessel anastomosis of the combined tissue transplantation, as well as the disposal of blood vessel crisis. Methods According to 284 history record of combined transplantation of 2, 3, 4,or 5 pieces tissue from December 1990 to December 2001, we summarized the cause of the blood vessel crisis, the finding and disposal of vessel surgical exploration, and the factors producing tissue necrosis. Results Among the 284 cases, the rate of vessel crisis was 12.68% (36 cases), and the exploration rate (32 cases) was 11.26%. Of all explorated cases, the survival rate (necrosis 10 cases) was 68.75%, accounting for 3.52% in the gross cases. During the exploration, the artery was all reanastomosed either directly or using vein graft. The failure reason included untimely surgery, vessel injury during surgical exploration, improper vessel arrangement. There were 4 failure cases without exploration, accounting for 1.41% in the gross cases. The general survival rate was 95.07%. The major reason causing vessel crisis was improper manipulation, the anastomosis stoma embolism, vessel compression and twist, and intractable vessel spasm. Conclusion The key point of success for the combined tissue transplantation was the appropriate selection of the supplied arteries and refluent veins at the supplied and received regions. For 2 or over tissue transplantation, series connection and/or parallel connection of the blood vessel should be chosen. The vessel exploration should be carried out within 48 hours when crisis occurred.