Improved technique of vascular anastomosis for small intestinal transplantation in rats

AIM To establish a new improved vascularanastomotic technique to simplify the surgicaltechnique and increase the survival rate of smallintestinal transplantation in rats.METHODS The graft removed en blocconsisted of entire small intestine,portal veinand aortic segment with superior mesentericartery.The graft was perfused in situ and thegut lumen was irrigated during the operation.Heterotopic small bowel transplantation wasperformed by microvascular end-to-sideanastomosis between the donor aortic segmentwith superior mesenteric artery and the recipientabdominal aorta,and by the formation of a'Cuff'anastomosis between the donor portalvein and the recipient left renal vein.Both endsof the grafts were exteriorized as stomas.RESULTS A total of 189 intestinaltransplantations were performed in rats,33 ofwhich were involved in the formal experimentalgroup,with a survival rate of 84.8%.Theaverage time for the donor surgery was 80min±10min;for graft repair 10min±3min;and forrecipient surgery 95min±15min.The averagetime for the arterial anastomosis and the veinanastomosis was 18min±5min and 1min,respectively.The warm ischemic time and coldischemic time were 22min±5min and less than60min,respectively.The whole operation wascompleted by a single surgeon,the operativetime being about 3 hours.CONCLUSION The vascular anastomosis used in this study could simplify surgical technique,reduce the operative time and elevate thesurvival rate of small intestinal transplantationin rats.

A new method for intraoral tissue defect repair:diepithelialized tissue flap with vascular anastomosis

Diepithelialized tissue flap(DTF)with vascular anastomosis was de-signed in August 1987,and was used for the repair of 12 cases of large intraoraltissue defect.All the operations were successful.The clinical data were reportedand the procedure to incise and transplant a DTF described.When the healingprocess and changes of DTF after transplantation were observed,it was foundthat a layer of new smooth epidermis was formed on the surface of the DTF.Theorigin of this new epidermis was discussed.Ten out of the 12 cases have been fol-lowed up for from half a year to 2 and a half years,and the results weresatisfactory.The new epidermis showed no hair growth and the patients did nothave any rough feeling,which usually occurred after ordinary skin grafting.It isbelieved that DTF transplantation is likely an ideal method for the repair andreconstruction of intraoral soft tissue defect.Its disadvantage was that the DTFcontracted severely after healing.Finally the authors put forward the problemsconcerning the transplantation of DTF,which should be investigated further.

Tongue Reconstruction with Free Forearm Radial or Ulnar Flap and Vascular Anastomosis:A Clinical Study of 21 Cases

Surgical treatment of tongue tumors usually results in a tongue defect half or more thanhalf of its original size which not only interferes with speech, swallow and mastication functions butalso creates contour deformity and induces mental suffering In order to restore the contour and func-tions of the tongue 21 cases of tongue defects were repaired and reconstructed with forearm radialor ulnar cutaneous or myocutaneous flaps All the transplanted flaps survived and the restored con-tour and functions were satisfactory. The surgical procedure of tongue reconstruction was intro-duced and how to have a satisfactory recovery of the tongue functions and raise the rate of successof the operation were discussed.

Effects of Taohong Siwu Decoction on coagulation function and PI3K/AKT/mTOR pathway after femoral artery anastomosis in rabbits

Objective:To observe the effect of Taohong Siyu Decoction on the coagulation function and the signaling pathway of PI3K(phosphatidylinositol 3-kinase)/AKT(protein kinase B)/mTOR(mammalian target of rapamycin)after femoral artery anastomosis in rabbits.Methods:30 New Zealand white rabbits were divided into blank control group,model control group,papavine hydrochloride injection group and low,medium and high dose groups of Taohong Siwu decoction by random number table method,with 5 rabbits in each group.The rabbits in the model control group,papavine hydrochloride injection group and low,medium and high dose groups of Taohong Siwu decoction were treated with the femoral artery simple intermittent end-to-end suture model.After the successful modeling,the low,medium and high dose groups of Taohong Siwu decoction were given the Taohong Siwu decoction,while the model control group,the blank control group and papavine hydrochloride injection group were given the same amount of normal saline.APTT(activated partial thromboplastin time),FIB(fibrinogen)and PI3K/AKT/mTOR concentrations were measured in aural venous blood samples from six groups of rabbits 30min before operation and 1d,2D,3D and 7d after operation,respectively.Statistical analysis was conducted on the data of the six groups.Results:Compared with blank control group,APTT of model control group was significantly shortened 1d to 7d after operation(P<0.05),FIB values were significantly increased from 1d to 7d after operation(P<0.05);Compared with model control group,APTT in Taohong Siwu decoction low-dose,medium-dose and high-dose groups were significantly prolonged 1d to 7d after operation(P<0.05),FIB value of Taohong Siwu decoction medium and high dose groups decreased significantly from 1d to 7d after operation(P<0.05),the FIB value of Taohong Siwu decoction low-dose group was significantly decreased from 2d to 7d after surgery(P<0.05);Compared with papaverine hydrochloride injection group,APTT in Taohong Siwu decoction medium dose group was significantly prolonged 2d to 7d after surgery(P<0.05),APTT of Taohong Siwu decoction high-dose group was significantly prolonged on 1d to 7d after operation(P<0.05).FIB in Taohong Siwu decoction medium and high dose groups decreased significantly 1d to 7d after operation(P<0.05);Compared with the blank control group,the expression concentrations of PI3K,Akt and mTOR in serum of the model control group were significantly increased from 1d to 7d after surgery(P<0.05);Compared with the model control group,the expression levels of PI3K,Akt and mTOR in serum were significantly increased in the low dose group of Taohong Siwu decoction and Papaverine Hydrochloride Injection group on postoperative 7 days(P<0.05),Taohong Siwu decoction high-dose group was significantly increased from 1d to 7d after surgery(P<0.05),the expression concentrations of PI3K and Akt in Taohong Siwu decoction medium dose group were significantly increased from 2d to 7d after operation(P<0.05),mTOR expression levels were significantly increased from 3d to 7d after operation(P<0.05);Compared with papaverine hydrochloride injection group,the expression concentrations of PI3K,Akt and mTOR in serum of Taohong Siwu decoction medium dose group were significantly increased from 3d to 7d after operation(P<0.05),the expression concentrations of PI3K and mTOR in Taohong Siwu decoction high-dose group were significantly increased from 1d to 7d after operation(P<0.05),and the expression concentration of Akt increased significantly from 3d to 7d after operation(P<0.05).Conclusion:The Taohong Siwu decoction can improve the coagulation function of rabbit femoral artery anastomosis,prevent thrombosis,activate PI3K/Akt/mTOR signaling pathway,promote angiogenesis,and improve tissue ischemia after artery anastomosis.

锁边缝合在内瘘血管吻合中的应用对动静脉内瘘通畅性的影响

目的探讨锁边缝合在内瘘血管吻合中的应用对动静脉内瘘通畅性的影响。方法回顾性分析2020年7月─2023年6月于贵州航天医院接受内瘘血管吻合手术的患者(n=256)。根据缝合方式分为2组:传统的手工缝合为手工缝合组(n=178),锁边缝合(用缝合器)的为锁边缝合组(n=78)。通过倾向性评分匹配(propensity score matching,PSM)法按照1:1匹配后2组各64例,比较2组患者治疗后疗效和并发症情况。根据治疗后6个月动静脉内瘘通畅情况将128例患者分为通畅组(n=81)和通畅不良组(n=47),采用单因素和多因素Logistic回归分析筛选患者动静脉内瘘通畅不良的独立影响因素,构建风险评估量表、危险分层及评估量表的预测价值及验证。结果匹配后锁边缝合组手术后1、6个月的吻合口直径(t=22.936、24.078,均P<0.001)、内瘘血流量(t=12.990、14.009,均P<0.001)、瘘管通畅率(χ^(2)=5.489、6.646,P=0.019、0.010)均优于手工缝合组,手术后并发症发生率低于手工缝合组(χ^(2)=19.384,P<0.001)。多因素Logistic回归分析显示平均动脉压≥70 mmHg(OR=3.355,95%CI:1.502~7.492,P=0.003)、吻合动脉手术前内径<3.5 mm(OR=2.344,95%CI:1.124~4.888,P=0.023)和吻合静脉手术前内径<3.5 mm(OR=2.177,95%CI:1.048~4.525,P=0.037)是患者动静脉内瘘通畅不良的独立危险因素,高血压史(OR=0.114,95%CI:0.049~0.265,P<0.001)、糖尿病史(OR=0.357,95%CI:0.168~0.759,P=0.007)和血磷≤1.78 mmol/L(OR=0.501,95%CI:0.239~1.047,P=0.006)是其保护因素。选取风险评估量表中3分作为最佳诊断界值,其灵敏度和特异性分别为79.8%和73.2%,得分≤2.5分通畅不良率风险为低危,3.0~4.0分为中危,≥4.5分为高危。用2022年7月─2023年6月的120例患者进行验证,其预测通畅不良的灵敏度为79.6%,特异性为78.9%,阳性预测值为70.6%,阴性预测值为85.6%。结论锁边缝合技术在动静脉内瘘血管吻合中的应用可以改善手术后的内瘘通畅性。其优势在于提供更稳固和可靠的吻合,减少手术后并发症的风险。

颈部无痕的舌癌颈淋巴清扫与游离皮瓣修复技术

颈淋巴清扫和修复重建是口腔癌治疗的两大重要内容。颈淋巴清扫和修复重建手术方法多种多样,但都是在开放手术下完成。该文报道一种经耳后发际入路完全腔镜下的颈淋巴清扫术;同期口内肿瘤根治性切除和经口原位血管吻合的旋髂浅动脉穿支皮瓣修复。颈淋巴清扫切口位于发际内,隐匿不可见,术后颈部无暴露性手术疤痕。现就这一术式作以介绍,并对其优缺点进行讨论。

吻合血管腓骨瓣治疗股骨头缺血性坏死的疗效观察

目的分析吻合血管腓骨瓣治疗股骨头缺血性坏死(ONFH)的临床疗效。方法2016年3月至2022年9月中南大学湘雅二医院骨科收治股骨头缺血性坏死患者23例(26髋),按照国际骨循环协会(ARCO)分期:Ⅱ期6例、ⅢA期15例、ⅢB期5例。术前髋关节Harris评分为(60.9±9.0)分。所有患者均采用吻合血管的腓骨瓣进行治疗,腓骨瓣近端距离腓骨头约10 cm,腓骨瓣长度约7 cm。除少数早期病例外,其余病例术中均未使用植骨材料或内固定装置。术后定期随访,进行影像学检查评估腓骨瓣愈合及股骨头坏死区域变化情况,评价髋关节功能。结果术后无伤口感染、下肢深静脉血栓形成等并发症。患者均获得随访,随访时间13~93个月。末次随访患髋Harris评分为(90.9±4.5)分,与术前相比差异有统计学意义(P=0.000)。影像学未见腓骨瓣移位,均愈合良好,无坏死区域进展。结论吻合血管的腓骨瓣治疗股骨头缺血性坏死能够有效改善患者髋关节功能。改良的手术方法和技术,使得腓骨瓣的切取、植入、固定等更加精准、有效。

双侧游离股前外侧肌皮瓣联合移植修复巨大胸壁缺损

目的总结双侧游离股前外侧肌皮瓣联合移植修复肿瘤根治术后遗留大面积胸壁全层缺损的疗效和经验。方法自2011年1月至2018年12月使用双侧游离股前外侧肌皮瓣联合钛合金支架或骨水泥重建完成22例胸壁全层重建术,患者胸壁缺损面积为300~700 cm^(2)(中位面积360 cm^(2)),共设计切取44块肌皮瓣,其中皮肤面积(173.55±67.78)cm^(2),肌瓣面积(158.68±94.93)cm^(2)。将皮瓣转移至胸壁缺损处,动脉行端-端吻合,根据可用受区动脉数量,采取外增压或内增压的方式重建2块肌皮瓣动脉血运。吻合静脉时,根据血管蒂及受区静脉数量与形态,采取不同的吻合策略。结果肌皮瓣全部存活,其中1块肌皮瓣远端部分坏死,清创后创面愈合。双侧大腿供区伤口全部顺利愈合,遗留线性瘢痕。术后随访6~36月,平均(18.27±8.62)月,所有患者未见局部复发,1例乳腺癌患者出现骨转移。重建胸壁质地良好,患者呼吸无明显异常,双下肢肌力、关节活动正常,患者满意度高。结论双侧游离股前外侧肌皮瓣联合移植能很好地覆盖胸壁缺损,根据不同的血管解剖特点切取肌皮瓣能最大程度保护供区功能,是行胸壁重建术的可靠方法。

口内血管吻合髂骨瓣修复颌骨缺损的临床应用

目的:介绍数字外科引导下利用口内血管吻合技术联合血管化游离髂骨瓣移植在颌骨重建中的临床操作与优势,探讨口内血管吻合技术的临床应用。方法:选取2022年武汉大学口腔医学口腔颌面外科3例因颌骨良性肿瘤需行颌骨切除并同期修复的患者,术前对患者进行颌骨及髂骨CT扫描,制定虚拟手术计划,设计、制作取骨截骨导板,手术切除肿瘤,其中2例为口内入路切除,1例为口外入路切除。截取髂嵴部带血管蒂骨瓣,以面动静脉为受区吻合血管与髂骨瓣血管蒂进行吻合,从而完成髂骨瓣对颌面部缺损的重建修复。随访患者术后恢复情况并进行评估。结果:3例手术均成功完成,其中2例患者无口外切口,1例患者仅有一处原发灶切除为口外切口。术后患者恢复良好,颌面部结构基本对称且美观。结论:口内血管吻合技术与髂骨瓣及虚拟手术计划相结合可以取得良好的术后结果。口内吻合技术不仅可以完成口内颌骨病灶切除后重建,对于需经口外入路切除病灶的病例也有一定优势。

机器人辅助肾移植术学习曲线探讨

目的探讨机器人辅助肾移植术(RAKT)的学习曲线。方法回顾性分析同一手术团队连续开展的96例RAKT患者的临床资料,选取动脉吻合时间、静脉吻合时间、输尿管吻合时间、住院时间、失血量作为评价指标,采用多因素累积和(CUSUM)分析RAKT的学习曲线,依据学习曲线图将其分为学习提高阶段和熟练掌握阶段,通过对比不同学习阶段患者的一般资料及手术资料验证学习曲线,分析各阶段临床疗效。结果学习曲线的最佳拟合方程在第33例时达到峰值,33例为掌握RAKT所需要累积的最少手术例数。学习提高阶段组和熟练掌握阶段组的年龄、性别、透析类型、既往腹部手术史、供肾动脉数量、术前血清肌酐差异无统计学意义(均为P>0.05)。与学习提高阶段比较,熟练掌握阶段体质量指数(BMI)较大,右侧供肾数量较左侧供肾增加(均为P<0.05)。两组动脉吻合时间、输尿管吻合时间、术后血清肌酐、并发症差异无统计学意义(均为P>0.05),熟练掌握阶段髂血管游离时间、热缺血时间、静脉吻合时间、失血量及住院时间优于学习提高阶段,差异均有统计学意义(均为P<0.05)。结论RAKT至少需要33例手术跨越学习曲线,学习提高阶段和熟练掌握阶段并发症和移植肾功能恢复无差异。

可降解血管吻合器的结构设计与实验验证

目的 设计一种新型可降解血管吻合器,探究施压距离与吻合口生物力学性能之间的关系,以提高血管端端吻合的效率与质量。方法 设计吻合器的三维结构,并采用挤压态高纯镁为材料进行样机加工;通过建立血管端端吻合的有限元模型,研究在不同施压距离(0.4、0.5、0.6、0.7、0.8 mm)下,血管吻合端面应力分布情况及其变化规律;通过离体组织吻合实验,对有限元结果的合理性及该吻合器的可行性与有效性进行验证。结果 当施压距离为0.6 mm时,吻合口力学性能最优,此时撕脱力为(11.79±0.64) N,爆破压为(39.32±2.99) kPa,满足临床上对组织吻合口强度的要求,同时组织的机械损伤较小。结论 本文所设计的新型可降解血管吻合器可以通过调节施压距离对组织进行吻合,能够有效提高组织吻合效率,减小组织机械损伤,从而提高吻合质量。研究结果为可降解血管吻合器的设计提供重要参考。

全内脏反位肝移植的研究进展

全内脏反位(SIT)是一种非常罕见的先天性疾病,在人群中发病率极低,不患病的SIT人群与普通人没有差别。但是当此类人群患病时,由于缺少对此类人群的认识,导致在对SIT人群进行诊断及治疗非常困难,尤其是SIT人群合并终末期肝病需要进行肝移植手术时,无论是SIT人群作为肝移植的供者或受者,对于外科医师而言都是巨大的挑战。本文通过查阅国内外近些年发表的SIT肝移植相关个案报道,对SIT肝移植在国内外的发展历程,SIT肝移植的关键步骤、预后及术后并发症等进行综述。

利伐沙班、低分子肝素对四肢血管吻合术后下肢深静脉血栓的临床疗效对比

目的 探讨利伐沙班、低分子肝素对四肢血管吻合术后下肢深静脉血栓(LDVT)的临床疗效。方法 收集2020年6月至2023年6月于青岛市第八人民医院行四肢血管吻合术的100例患者的临床资料,按照术后应用药物的不同将其分为低分子肝素组(n=46)与利伐沙班组(n=54)。比较治疗前、治疗14 d后两组患者凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D)],出院前统计两组患者LDVT发生情况,比较两组患者出血事件发生率。结果 治疗后,两组患者PT、APTT均长于本组治疗前,FIB、D-D水平均低于本组治疗前,且利伐沙班组患者D-D水平低于低分子肝素组患者,差异均有统计学意义(P﹤0.05)。利伐沙班组患者LDVT总发生率为1.85%(1/54),低于低分子肝素组患者的15.22%(7/46),差异有统计学意义(P﹤0.05)。两组患者出血事件总发生率比较,差异无统计学意义(P﹥0.05)。结论 与低分子肝素相比,利伐沙班可降低四肢血管吻合术患者LDVT的发生风险,安全可靠,值得临床进一步推广应用。

显微血管缝合技术的临床研究进展综述

血管吻合是显微外科最基本的技术之一,吻合质量的好坏很大程度上决定了手术的成功与否。随着显微外科技术的不断发展,越来越多的新技术被用于血管吻合中,但手工缝合法目前仍然是显微血管吻合的“金标准”方法。本文对国内外传统显微血管缝合技术与方法和改良技术与方法的优缺点及应用情况进行综述,以期为显微血管缝合技术的临床应用提供参考依据。

微血管无缝线吻合技术的研究进展和应用前景

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。

大鼠原位肝移植解剖重建研究进展

大鼠肝移植模型的构建,为解决临床肝移植术后并发症及围手术期治疗等问题提供了理想的动物模型。随着对大鼠肝移植模型建立的深入研究,逐渐形成了经典的“二袖套”法。然而,在移植手术过程中,手术视野差、血管扭转、胆道损伤和无肝期较长等问题仍是传统方法无法避免的。目前国内外大鼠肝移植模型改进方式主要围绕肝上下腔静脉、门静脉、肝下下腔静脉和胆管这4个重要解剖结构的重建展开。为此,本文就肝上下腔静脉、门静脉、肝下下腔静脉和胆管重建领域的最新进展进行整理总结,以便为大鼠肝移植模型的构建提供参考,促进肝移植技术的进一步发展。

巴马香猪原位肾脏移植模型的建立及手术方式效果对比

目的构建猪猪原位肾脏移植模型并探讨不同血管吻合方式的效果以及并发症发生率。方法采用整块供肾切取术获取肾脏,移植肾修整后,行移植肾动静脉与受体猪动静脉端端吻合的原位肾移植。根据血管吻合方式不同,分为传统吻合组(n=12)和显微吻合组(n=12),比较两组动脉吻合时间、静脉吻合时间、总体手术时间、肾脏冷缺血时间、肾脏热缺血时间以及血管相关并发症发生率。结果传统吻合组动脉吻合时间、静脉吻合时间、总体手术时间、肾脏冷缺血时间均低于显微吻合组,传统吻合组血管并发症发生率高于显微吻合组。结论猪猪原位肾脏移植模型具有较强的可操作性且供受者间肾动静脉显微吻合有助于减少移植肾血管并发症。

以腓肠肌内侧头动脉供血的游离股前外侧皮瓣修复小腿复杂创面的临床研究

目的探讨以腓肠肌内侧头动脉为受区供血动脉的游离股前外侧皮瓣修复小腿复杂创面的手术方法及临床疗效。方法回顾性分析2020年10月—2022年9月苏州瑞华骨科医院收治的11例小腿复杂创面患者的临床资料。患者均存在小腿大面积皮肤及皮下软组织缺损,均接受游离对侧大腿股前外侧皮瓣修复,受区以腓肠肌内侧头动脉为供血动脉,供区皮肤直接缝合。结果11例患者11块游离皮瓣均成活,供区、受区创面均Ⅰ期愈合。出院后患者均获随访,随访时间12~35个月。术后12个月随访结果显示,所有患者创面愈合良好,皮瓣外观、弹性良好;所有患者恢复正常膝、踝关节功能,具有自主生活能力;供区伤口愈合良好,无明显瘢痕增生。末次随访时,皮瓣感觉功能评定为S 3级者2例、S 2级者9例;患肢功能评分达优者5例、良者6例,优良率高达100%。结论腓肠肌内侧头动脉血管口径适于吻合、位置恒定,以该动脉供血的游离股前外侧皮瓣修复小腿严重创面,可有效覆盖软组织缺损,并避免损伤小腿残留主干血管,疗效满意。

脑-硬膜-动脉-颞肌血管融通术治疗前循环急性脑缺血效果观察

目的 对现有颅内外血管间接吻合术进行改进,与传统方法比较其疗效的优越性。方法 回顾性分析江南大学附属医院2012年1月至2020年10月收治的48例亚急性缺血性脑血管病患者的临床资料,按手术方式不同分为对照组与观察组各24例。观察组将充分剥离外膜后的颞浅动脉顶支游离端植入分离后的侧裂岛环沟上沟,将颞筋膜分离后的颞肌植入岛环沟下沟,颞筋膜贴敷于剥离蛛网膜后的脑表面,对照组为单纯颞肌贴敷。随访比较两组美国卫生研究院卒中量表(NIHSS)评分,梗死面积及CT脑灌注成像(CTP)数据。结果 观察组NHISS评分、梗死面积和CTP均优于对照组,差异有统计学意义(P <0.05)。结论 改进后血管融通术式有利于颅内外侧支吻合的建立,扩大了供受体接触面积,提升缺血脑组织血流储备,改善预后。

TREATMENT OF ISCHEMIC NECROSIS OF FEMORAL HEAD BY THE FREE TRANSFERRING FIBULAR BONE GRAFT WITH VASCULAR PEDICLE IN ADULTS: A REPORT ON 95 CASES

cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.