定点牵引医用胶粘结吻合微小血管的实验与临床应用

目的探讨新的细小血管吻合安全、快捷的方法。方法SD大白鼠40只,一侧股动脉后壁和前壁正中各缝合1针作为定点牵引,蘸胶端-端粘结吻合为实验组,另一侧行常规针线法端-端吻合为对照组,取2只动物两侧股动脉做吻合口耐压实验,其余动物分别于术后1、2、3、4周取血管标本,采用组织学和扫描电镜观察吻合口愈合情况,并在临床应用于断指再植52例79指。结果两侧血管全部吻合通畅,粘合组用时(12±2)m in比针线组(18±3)m in缩短1/3,粘合组吻合口耐压(300 mm Hg)优于针线组,吻合口组织学观察两组无明显差异,电镜观察粘合组内膜修复更为平整、光滑;临床应用于断指再植成活率94.9%。结论定点缝线牵引蘸胶端-端粘结吻合显微细小血管快速、安全、效果可靠,具有较大临床应用价值。     

改良粘接法与针线法显微血管吻合术后对ET-1影响的比较实验研究

目的比较改良粘接法与针线法显微血管吻合术后对实验性大鼠血浆血管内皮素(ET-1)的影响。方法成年健康Wistar大鼠48只,随机分为2组,以戊巴比妥钠(30mg/kg)腹腔内注射麻醉后,尾动脉行改良粘接法(血管内置中空支架蘸胶端-端直接粘接吻合法)吻合为实验组,尾动脉行常规针线缝合端-端吻合法吻合为对照组;分别记录血管吻合时间;并于术后1周、4周、16周,股动脉取血测血管内皮素ET-1。结果手术时间,改良粘接法组显著短于对照组(P0.01);术后1周实验组的ET-1与对照组有差异无统计学意义(P0.05);4周、16周实验组的ET-1与对照组有显著性差异((P0.05));实验组ET-1含量较对照组显著降低;且随时间推移2组差异更加显著。结论改良粘接法快速、对血管内皮损伤小、具有较好临床应用前景。     

医用胶黏合法吻合兔细小血管的实验研究

目的探索医用胶黏合法行兔细小动脉血管吻合的可行性。方法新西兰兔12只,麻醉,暴露并切断双侧股动脉,按随机原则,一侧股动脉应用传统显微外科缝合法吻合(对照侧);另一侧应用可吸收缝合线血管外搭桥发挥牵引和支撑作用,α-氰基丙烯酸正丁酯医用胶黏合法吻合血管(实验侧)。比较两种吻合方法的操作时间、炎性细胞浸润数量及吻合血管后的血流速度变化。结果相比对照侧,实验侧所需手术时间少(P 0.001),吻合口炎性细胞少(P0.01)。术后3 d、7 d,实验侧的血管通畅程度优于对照侧,差异显著(P0.01),术后5周时两侧吻合口无明显差异(P0.05)。结论缝线血管外支撑和牵引辅助下,以医用胶黏合血管断端,可缩短手术耗时,吻合口血管壁炎性反应轻,且通畅程度优于或不差于传统显微外科吻合法。     

镍钛合金吻合夹吻合血管的扫描电镜观察

目的分析镍钛合金吻合夹吻合血管后吻合口部的扫描电镜观察结果.方法新西兰大白兔10只,选取一侧颈动脉以镍钛合金吻合夹行端-端吻合为实验组,另一侧行针线法端-端缝合为对照组.分别于术后1 d、1周、2周、1个月取血管标本,采用扫描电镜观察吻合口部愈合情况.结果所有20条血管均吻合成功,吻合夹法用时(8±3.2)min明显少于针线法(15±4.5)min.镍钛合金吻合夹吻合血管后吻合口部内皮细胞再生早,内膜更为光滑.结论镍钛合金血管吻合夹吻合血管快速、安全、可靠,具有良好的应用前景.     

梯形对称二等分叶法吻合小血管

目的　探索一种安全、快捷的小血管吻合方法。方法　将吻合口管壁两侧 0°和 180°位斜形4 5°对称剪去一小等腰三角形管壁 ,剪去三角形的各边为血管管径的 1/3,使吻合口管壁前后呈梯形对称二等分叶 ,先用两定点缝合法吻合 0°和 180°位叶间 ,而后缝合梯形叶部和梯形叶边。结果　大鼠尾动脉 2 0个吻合口、颈总动脉和股动脉 4 0个吻合口 ,即刻通畅率 10 0 %。大鼠颈总动脉和股动脉吻合口近期通畅率 (2周 )为 10 0 % ,吻合前后血管口径无明显狭窄 (P >0 0 5 )。吻合口经光镜及扫描电镜观察愈合过程良好。临床应用 2 4例全部成功 ,未发生血管危象。结论　该法吻合小血管克服了对端吻合法中两定点吻合时进针困难的缺点 ,最大限度地减少了血管内膜损伤机会 ,避免了小血管吻合时误穿对侧管壁的弊端 ,确保吻合口管壁完全外翻 ,内膜平整对合。该法操作简单 ,吻合速度快 ,通畅率高 ,可减少血管危象发生 ,值得临床推广应用     

血管直接粘接吻合方法的实验研究

目的为了进一步研究血管粘接吻合的方法，并观察在体通畅情况。方法设计采用氰基丙烯酸酯医用胶、血管内置速溶中空支架和密封剂，选择兔颈总动脉，进行血管端端直接粘接吻合，将所得的吻合口与传统缝合的进行比较，从手术操作、大体外观和力学特性等方面进行比较研究；重点观察了血管粘接吻合口通畅后中远期的变化（5个月），并对血管粘接吻合口进行病理和超微结构观察。结果手术时间，直接粘接组显著短于缝合组（P〈0．01）；一维拉伸和二维爆破压的数值，所有粘接组所能承受的强度明显大于缝合对照组（P〈0．01）。5个月的血管通畅率为3／5，粘接吻合口的病理和扫描电镜显示，吻合口内膜光滑，细胞和组织生长紧密，粘接剂已被吸收，或被包裹于吻合口两边。但粘接后吻合口弹性差、质脆、有毒性等尚需进一步改进。结论血管粘接吻合法的手术速度及强度均优于缝合法，是血管吻合可行的方法。     

OB胶加固气管、支气管成形处及支气管残端的实验研究与临床应用

目的:探讨OB胶加固气道成形处及支气管残端(残端)的作用。方法;9头成年杂种猪宰杀后即刻取其完整气道,常规切除所有肺叶(54叶),随机法对残端结扎(27支)、缝合(27支);在气管/支气管上作切开/切除-缝合/修补模型36处,比较OB胶加固前后或加固与否气道成形处及残端的耐压程度;观察OB胶的固化过程。总结OB胶加固气道的临床经验,包括30例肺切除后的残端,5例袖式肺叶切除后的支气管吻合口,10例食管癌累及气道的成形缝合。结果:OB胶加固后气道成形处的耐压程度明显高于单纯缝合者(kPa,P<0.01),切开缝合处分别为18.0±5.0,2.0±0.5;切除修补处分别为14.0±3.0,1.0±0.2;缝合残端分别为27.5±5.5,8.5±1.0。OB胶与组织紧密结合形成一固化的半透明膜填堵缝合间隙。临床应用OB胶加固气道破口、吻合口或残端45例,效果良好,无毒副作用,无死亡,无相关并发症发生,近期疗效满意。结论:OB胶加固气道修补处、吻合口、残端,简单方便、安全可靠、无毒副作用;增加了手术安全性;拓宽了手术适应证。     

应用医用胶和可溶性小血管支架粘接小动脉的实验研究

常规间断缝合法吻合小血管难度大,需时长。我们应用国产医用胶和可溶性小血管支架法粘接兔小动脉的实验研究,只需在12点、6点处缝合两针,置入小血管支架,将两断端严密对齐,吻合口处涂布医用胶,待胶固化后,吻合便告完成,操作简便,省时。远期通畅率、吻合口的修复过程与间断缝合法相比较,基本一致。     

应用医用胶和可溶性小血管支架粘接小动脉的实验研究

常规间断缝合法吻合小血管难度大，需时长。我们应用国产医用胶和可溶性小血管支架法粘接兔小支脉的实验研究，只需在１２点、６点处缝合两针，置入小血管支架，将两断端严密对齐，吻合口处涂布医用胶，待胶固化后，吻合便告完成，操作简便，省时。远期通畅率、吻合口的修复过程与间断缝合法相比较，基本一致。     

应用医用胶和可溶性小血管支架粘接小动脉的实验研究

常规间断缝合法吻合小血管难度大，需时长。我们应用国产医用胶和可溶性小血管支架法粘接兔小动脉的实验研究，只需在１２点、６点处缝合两针，置人小血管支架，将两断端严密对齐，吻合口处涂布医用胶，待胶固化后，吻合便告完成，操作简便，省时。远期通畅率、吻合口的修复过程与间断缝合法相比较，基本一致。     

Gastrointestinal anastomosis with histoacryl glue in rats.

Technical difficulties in creating gastrointestinal anastomosis in infants and young children, because of the small lumen, are well known and may be complicated by a narrow passage, anastomotic obstruction, gastric stasis, recurrent vomiting, and failure to gain weight. The search for alternative easier technique was the basis for this study. The primary aim was to evaluate the safety of anastomosis between the stomach and a loop of the jejunum performed by using the tissue adhesive Histoacryl glue in comparison with the same anastomosis performed conventionally with absorbable sutures. We compared the results of gastrojejunal anastomosis in rats using either Histoacryl (n-butyl cyanoacrylate) glue or continuous, absorbable sutures. Sixty-four Sprague-Dawley rats were divided into 4 groups of 16 rats each. Gastroenterostomy was performed with either type of anastomosis with and without truncal vagotomy. The criteria ofgastroenterostomy investigated included anastomotic leakage, stricture formation, adhesion formation, and histological examination. The pH of gastric secretion was measured with intact gastric innervation and after vagotmy in all rats. The time to complete each type of anastomosis was measured in minutes. Anastomotic stricture, leak, peritonitis, and death happened in three rats in each group with intact vagal innervation, in two rats after vagotomy and anastomosis with Histoacryl, and in one rat after vagotomy and anastomosis with sutures. The results showed no statistically significant differences between the various groups, except the shorter time for performing the glued anastomosis (5-7 min) compared to the conventional anastomosis (16-21 min). In conclusion, gastroenterostomy with Histoacryl in rats appears to be as safe as conventional suture anastomosis, saves operating time, and is not affected by gastric acidity.     

微型血管吻合夹与针线吻合方法的比较研究

目的 为显微外科探索更理想的血管吻合方法。方法 选用新西兰兔20只，以颈动脉为吻合血管，左侧用微型吻合夹吻合，右侧用传统针线吻合，对比研究两种吻合方法其吻合口术后第1天、第14天手术显微镜、光镜及电子显微镜下的组织变化。结果 针线吻合法用时平均15分钟，吻合夹法用时为2－5分钟；两组吻合方法的血流通畅率相同；吻合口内皮细胞生长速度相似，但是，吻合夹不损伤血管内膜，管腔内无异物。结论 微型血管吻合夹方法操作简便，可明显节省吻合时间，并减少血栓形成因素，吻合效果可靠。     

Gastrointestinal Anastomosis With Histoacryl Glue in Rats

Technical difficulties in creating gastrointestinal anastomosis in infants and young children, because of the small lumen, are well known and may be complicated by a narrow passage, anastomotic obstruction, gastric stasis, recurrent vomiting, and failure to gain weight. The search for alternative easier technique was the basis for this study. The primary aim was to evaluate the safety of anastomosis between the stomach and a loop of the jejunum performed by using the tissue adhesive Histoacryl glue in comparison with the same anastomosis performed conventionally with absorbable sutures. We compared the results of gastrojejunal anastomosis in rats using either Histoacryl (n-butyl cyanoacrylate) glue or continuous, absorbable sutures. Sixty-four Sprague-Dawley rats were divided into 4 groups of 16 rats each. Gastroenterostomy was performed with either type of anastomosis with and without truncal vagotomy. The criteria of gastroenterostomy investigated included anastomotic leakage, stricture formation, adhesion formation, and histological examination. The pH of gastric secretion was measured with intact gastric innervation and after vagotmy in all rats. The time to complete each type of anastomosis was measured in minutes. Anastomotic stricture, leak, peritonitis, and death happened in three rats in each group with intact vagal innervation, in two rats after vagotomy and anastomosis with Histoacryl, and in one rat after vagotomy and anastomosis with sutures. The results showed no statistically significant differences between the various groups, except the shorter time for performing the glued anastomosis (5-7 min) compared to the conventional anastomosis (16-21 min). In conclusion, gastroenterostomy with Histoacryl in rats appears to be as safe as conventional suture anastomosis, saves operating time, and is not affected by gastric acidity.     

Microvascular anastomosis using cyanoacrylate adhesives

This paper describes a new technique for microvascular anastomosis, which involves the overlapping of the adventitias of the two ends of a severed blood vessel, and then painting a cyanoacrylate adhesive on the outer surface of the vessel around the anastomosed part. Sixteen anastomoses were performed in both radial arteries and cephalic veins in eight dogs. All vessels were patent without thrombus. The described method of anastomosis was faster and easier to perform than the conventional suture anastomosis. Histologic studies revealed that the adhesive did not flow into the lumen, and that normal healing of the endothelium and of the internal elastic lamina occurred across the anastomotic site, even though the adhesive remained on the adventitial side of the vessel at 4 weeks. This technique deserves to be considered as an alternative to conventional suture anastomosis.     

硝苯地平对大鼠颈总动脉端端吻合术后血流速度的影响

目的 研究硝苯地平（ｎｅｆｅｄｉｐｉｎｅ））对小动脉端端吻合后血流速度的影响。为血管吻合后临床应用硝苯地平的时间提供依据。方法 取ＳＤ大鼠４８只,切断左侧颈总动脉后作端端吻合。按术后所给药物的不同随机分成两组。实验组：术后用硝苯地平灌胃（１．０ｍｇ／ｋｇ）;对照组用同等体积生理盐水灌胃。按给药时间又分成术后２４、４８和７２ｈ３个给药时间组。每组均在给药后１、３、５和７ｈ,用彩色多普勒超声仪检测左侧     

Arterial anastomosis using the telescoping method and an elastomeric adhesive

We experimentally studied a new technique for anastomosis of small arteries which involves the telescoping method and a surgical adhesive with the objective of examining its clinical potential. This technique was applied to the unilateral femoral arteries of 27 mongrel dogs. After division of the artery, the distal artery was incised longitudinally, and the proximal end was invaginated into the opened artery. One stay suture and the elastomeric adhesive PUP201 were placed in the anastomotic site. The bursting and tensile strength and the patency were examined, and a histopathological study was performed at various intervals up to 1 year after the operation. The bursting strength exceeded 500 mm Hg. The patency rate of the anastomosed arteries was 100%. The mean percentage of stenosis to diameter of the proximal normal lumen was 20% one year after operation. The luminal surface of the anastomosed line was healed smoothly, and thrombi between the telescoped arteries were replaced by elastofibrotic union. In conclusion, small arterial anastomosis using the telescoping method and an elastomeric adhesive is easy and safe and provides good patency.     

End-to-end microvascular anastomosis in the rat carotid artery using continuous horizontal mattress sutures

This paper reports a continuous horizontal mattress suture technique with advantages such as decreased time for anastomosis, minimized anastomotic leakage, eversion around the vessel edges, and other advantages which the continuous anastomosis technique has. This technique was compared with the classical interrupted and classical continuous suture techniques on a total of 59 Sprague-Dawley rat common carotid arteries: Group 1 (n = 19), interrupted suture technique; Group 2 (n = 20), standard continuous technique, and Group 3 (n = 20), continuous horizontal mattress technique. Early (30 min) and late (21 days) patency rates, anastomosis time, leakage on clamp release, oozing duration, additional sutures needed, and total number of sutures placed were statistically compared between groups. Specimens were taken at the 21st day randomly, and light microscopy (LM), scanning electron microscopy (SEM), and angiographic studies were performed. Results revealed that the continuous mattress suture technique has the advantages of providing a water-tight anastomosis with less suture materials in a shorter time, and minimal intraluminal suture material which can incite thrombosis. On the other hand, a tendency to anastomotic stricture was found to be the sole disadvantage of this technique.     

A new microvascular anastomosis technique using muscle graft

A novel microvascular anastomosis technique is described. Forty-five male Sprague-Dawley rats were divided equally into three groups before undergoing femoral artery anastomosis. The first group received standard eight-suture anastomotic repair. Group 2 (muscle group) received three sutures plus autogenous muscle graft wrapped around the anastomosis. In group 3 (fascial surface group), a muscle graft was wrapped around the anastomosis with the fascial side of the graft facing the anastomosis. Significantly less time and suture usage were noted using both fascial surface and muscle groups compared with controls (p??0.05). Additionally, grade 2 anastomotic leakage was less frequent in the study groups compared with the control group (p?相似文献   

山莨菪碱对大鼠颈总动脉吻合术后血流动力学的影响

目的研究山莨菪碱对血管吻合后血流动力学的影响。方法取ＳＤ大鼠９６只，切断左侧颈总动脉作端端吻合后，随机分成术后６、１２、２４、４８、７２和１２０小时共６个时间组。各时间组再分成实验组和对照组，每组８只大鼠。实验组用２％氢溴酸山莨菪碱（３０ｍｇ／ｋｇ）作腹腔注射，对照组则注射等体积生理盐水，给药１０分钟后用彩色多普勒血流仪检测颈总动脉吻合口前、吻合口、吻合口后动脉收缩期平均最高血流速度，并计算吻合口横截面积。结果术后１２、２４、４８、７２和１２０小时组，颈总动脉吻合口前的血流速度比对照组明显增加（Ｐ＜０．０５），平均增加３１．５％。术后６和２４小时组，实验组吻合口狭窄程度比对照组明显减轻（Ｐ＜０．０１，０．０５）。术后１２０小时组，山莨菪碱能够明显增加吻合口后的血流速度，实验组和对照组相比有显著性差异（Ｐ＜０．０５）。结论山莨菪碱能够提高大鼠颈总动脉吻合后，血管吻合口前及吻合口的血流速度，术后２４小时内用药能够减少吻合口的狭窄程度。