微型吻合夹吻合血管的生物力学研究

我们应用微型吻合夹吻合动物血管,对吻合口进行生物力学测定,以了解吻合口的耐张及耐血压强度,并与传统的针线吻合法进行对比研究。 一、材料和方法 1.微型吻合夹及其配套器械:微型吻合夹以纯钛材料制成,呈“C”形,按内径分为0.6、0.9及1.2 mm 3种。本实验采用内径为0.9 mm吻合夹。吻合夹由持夹器夹持,吻合血管时将吻合夹“C”     

微型吻合夹在吻合血管游离皮瓣移植中的应用

吻合血管的游离皮瓣移植是现代整形外科一项重要治疗手段 ,而针线缝合技术是现在最常用、最成熟的一种血管吻合方法 ,但是统计资料表明目前仍有高达 5 %的失败率。究其原因 ,主要与缝合针线损伤血管内膜 ,引起内膜下胶原暴露、血小板沉积、血栓形成等有关。针线吻合法另一不足是操作复杂 ,手术耗时较长。为克服这些不足 ,我们采用 C形微型吻合夹方法进行血管吻合 ,即将吻合夹 C形缺口对准靠拢外翻的吻合口用力压紧 ,依次间断吻合血管一周 ,共需吻合夹 6～ 8个。 1998年～ 2 0 0 1年 5月共行游离皮瓣移植术 2 2例 ,其中男 15例 ,女 7例。年…     

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.     

应用新型血管吻合夹吻合血管后的血流动力学实验研究

目的　探讨镍钛合金血管吻合夹吻合血管后吻合口部的血流动力学变化。　方法　新西兰纯种成年大白兔 1 5只 ,随机分为吻合夹组、针线组和空白对照组 ,每组 5只。随机选取一侧颈动脉切断 ,吻合夹组以镍钛合金吻合夹行端端吻合 ;针线组行端端吻合 ;空白对照组分离出颈动脉后不做任何处理 ,关闭伤口。三组分别于术后 3、9、2 1及 30天 ,采用彩色多普勒超声诊断仪检测吻合口部平均血流速度 (Vm)、血管搏动指数 (PI)及血流阻力指数 (RI)三项血流动力学指标。　结果　术后 3、9天吻合夹组与针线组的血流动力学指标无统计学差异 (P>0 .0 5) ,术后 2 1、30天时两组Vm、RI均有统计学差异 (Vm分别为 P<0 .0 1 ,P<0 .0 5;RI分别为 P<0 .0 1 ,P<0 .0 5)。综合评价 ,吻合夹组的血流动力学指标恢复情况更接近空白对照组。　结论　镍钛合金吻合夹吻合血管后吻合口部血流动力学特征优于针线缝合法 ,吻合夹吻合血管快速、安全 ,且可靠 ,具有良好的应用前景     

蘸胶粘接法与针线法吻合细小血管的比较研究

目的探讨吻合细小血管更理想、安全、快捷的方法。方法大白鼠40只,左侧股动脉后壁和前壁正中各缝合1针作为定点牵引,蘸胶粘接法端-端吻合为实验组,右侧股动脉行常规针线法端-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周、2周、3周、4周取血管标本,采用光学显微镜和扫描电镜观察吻合口部愈合情况。结果两侧血管全部吻合通畅,粘接法用时(12±2min)比针线法(18±3min)缩短1/3,粘接法吻合口耐压(300mmHg)优于针线组,吻合口电镜观察粘接法内膜更为平整、光滑。结论定点缝线牵引蘸胶粘接法端-端吻合显微细小血管快速、安全、效果可靠,具有较好临床应用前景。     

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。     

镍钛记忆合金加压吻合夹在36例肠道吻合术中的应用

目的评价新型镍钛记忆合金加压吻合夹(CAC)在肠道吻合术中的临床应用效果。方法自2008年1月以来,我科将新型镍钛记忆合金加压吻合夹应用在36例肠道吻合术中,所有病例均以侧侧吻合,其中包括小肠-小肠吻合15例,回肠-结肠吻合10例,结肠-结肠吻合11例。结果本组36例手术均获得成功。全组无吻合口瘘或肠梗阻等严重并发症发生。吻合操作时间为9.6±2.8分钟,术后排气时间为3.5±1.4天。吻合夹排出体外时间为13.1±6.8天。结论新型镍钛记忆合金加压吻合夹用于肠道吻合术中,具备安全可靠、操作简便、实用性强等特点。     

等距对称分叶法吻合小血管的实验及临床应用研究

目的：吻合口管壁等距对称分叶后吻合小血管，确保吻合口管壁完全外翻；内膜平整对合，降低血管危象的发生率，提高通畅率。方法：将吻合口管壁纵形剪开分叶，剪开的深度为管壁厚的２倍，小血管分３叶者吻合６针，４叶者８针。用二定点法先缝合叶部，后缝合２叶之间。用此法共吻合大白鼠尾动脉１００个吻合口，免股动脉和肱动脉１２０个吻合口，免耳皮瓣自体交叉移植２０个，用此法进行断手指再植１５例，游离皮瓣移植５例。结果：１００个大白鼠尾动脉吻合后即刻通畅率为１００％，１２０个股、肱动脉吻合后３周其通畅率为９７．５％（３个吻合口因伤口感染栓塞），吻合前、吻合后３周时吻合口内径经ｔ检查无显著差异（Ｐ＞０．０５），兔耳皮瓣全部成活，临床应用２０例全部成功。未发生血管危象。吻合口经扫描电镜观察，愈合过程优于端端吻合法。结论：此法吻合微小血管能确保其吻合口管壁外翻，内膜平整对合，减少缝合针数。有利于吻合口的无创操作，使血管的通畅率提高，血管危象减少     

小血管外膜牵引吻合法实验研究及临床应用

小血管吻合方法甚多,各有其优缺点。我们设计了一种外膜牵引吻合法,具有较多优点,介绍如下。 材料和方法 家兔6只,体重1460～2100g,苯巴比妥钠麻醉,实验侧用本法进行股动静脉切断吻合实验,对照侧用通用联臂双血管夹作血管切断吻合。两操作由同一手术组完成。 血管吻合方法:显露血管后,距血管断     

应用镍钛记忆合金加压吻合夹进行结肠吻合的临床研究

目的评价一种新型的镍钛记忆合金加压吻合夹（CAC）进行结肠吻合的安全性及有效性。方法2005年4月至2006年2月，南京军区南京总医院将30例结肠癌病人随机分为两组，各15例。研究组使用CAC进行结肠吻合，对照组使用常规吻合器进行结肠吻合。术后观察有无发生与吻合相关的并发症，肠道排气、排便时间，CAC的排出时间。结果两组术后均无吻合口瘘、吻合口狭窄或梗阻等并发症发生。术后肠道排气、排便时间无差异。研究组CAC于术后8～14d均排出体外。结论应用CAC进行结肠吻合安全可靠．使用简便。     

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.     

Clinical experience with non-penetrating vascular clips in free-flap reconstructions.

To date, the gold standard for performing a microvascular anastomosis has been the penetrating suture with attached needle. During the last two decades, non-penetrating techniques have been introduced, including the Unilink system for end-to-end anastomoses, and the VCS clip-applier system for both end-to-end and end-to-side anastomoses. The aim of this study was to compare the results of different techniques used to create microvascular anastomoses in free-flap reconstructions. Between January 1995 and October 1999, we performed 474 microvascular anastomoses in 216 consecutive free-tissue transfers. The anastomosis techniques included manual sutures (42%), Unilink rings (34%) and VCS clips (24%). Seven combined sutured-clipped anastomoses were excluded from further analysis. The mean anastomotic time when rings were applied was significantly shorter than when using clips (P 0.0001) or sutures (P 0.0001). Venous anastomoses using clips took less time than those using sutures (P 0.05). There were 19 anastomotic failures, all of which lead to early flap failure. Ten flaps were salvaged by early reoperation; nine flaps were lost. Three more flaps were lost as a result of other causes, bringing the flap survival rate down to 94.4%. Early flap failure was caused by failure of the arterial anastomosis in eight cases; all of them were sutured (these represented 5% of all arterial anastomoses with sutures). None of the clipped arterial anastomoses failed. Early flap failure was caused by failure of the venous anastomosis in 11 patients. Three of these anastomoses were sutured (representing 6% of all venous anastomoses with sutures), seven were anastomosed with rings (representing 5% of all venous anastomoses with rings) and one was clipped (representing 2% of all venous anastomoses with clips). Both the VCS clip-applier system and the Unilink system are easy to handle and allow fast microvascular anastomoses without intraluminal penetration. The patency rate of clipped vessels is at least as good as the patency rates of vessels anastomosed using sutures or rings.     

End-to-end Anastomosis in Growing Vessels Using a Novel Suturing Technique: VCS Metallic Staples

For pediatric transplants, a suturing technique is needed that allows the vessel to grow along with better healing of the anastomosis, through eliminating exogenous and thrombogenic material in the intimal side, thus minimizing the risk of vascular stenosis. In this study, 12 55-day-old lambs were subjected to end-to-end anastomosis of the right carotid artery and external jugular vein using vascular closure staple (VCS) clips (the vessels from the left side served as controls). Animals were followed up with duplex ultrasound. After 6 months, angiography was performed and animals were euthanized for microscopic study of the vessels. Duplex ultrasonography and angiography showed all vessels to be patent, with no flow disturbances and no stenosis at the anastomotic site at 6 months. Stenotic segments caudal to the anastomosis site were seen in two veins. No significant changes were seen macroscopically in any of the veins, whereas one of the arteries developed a pseudoaneurysm at the anastomotic site. Histological structure was normal in all the studied veins. Arteries showed different degrees of modifications that did not affect patency or flow in any case. Measurements taken after 6 months confirm that this technique allows the vessel to grow. This technique may be useful in vascular pediatric surgery.     

Arterial reconstruction with vascular clips is safe and quicker than sutured repair.

BACKGROUND: Non-penetrating, arcuate-legged vascular-closure staple clips made of titanium were initially developed for microvascular anastomoses with little experience of their use in larger vessels. The purpose of this study was to compare vascular-closure staple clips to sutured anastomoses in common iliac arteries in a porcine model. METHODS: In an experimental study, transected iliac arteries on both sides of 11 pigs were randomly assigned to end-to-end anastomosis performed with vascular-closure staple clips or interrupted 6-0 polypropylene sutures. Angiographic, macroscopic and microscopic results were assessed after 2 months. RESULTS: There was no significant difference in the patency rate, tensile strength of the anastomoses, vessel diameter at the repair site, intimal thickness or wall thickness of the arteries after either method of closure. The mean (s.d.) clamp time was 19.8 (6.1) minutes for clip repair, and 36.0 (6.9) seconds for suture repair (P < 0.001). The times required for the reconstruction of the anastomoses were 17.4 (6.1) and 35.5 (7.1) minutes, respectively (P < 0.001). CONCLUSIONS: Arterial anastomoses performed with vascular-closure staple clips are faster than sutured anastomoses, and result in comparable wound healing when assessed for patency, tensile strength, degree of narrowing and intimal reaction.     

Late Results of Clinical Experience with Small Caliber Biological Grafts

Abstract: Small caliber biological grafts that were hepa-rinized and nonheparinized were implanted in 52 patients with arterial obstructive disease and chronic renal failure by either conventional suture anastomosis or laser anastomosis over the last 8 years. There were no operative mortalities. The overall postoperative patency rate was 91% at 1 year, 85% at 3 years, and 82% at 5 years. The heparinized graft anastomosed by laser clearly had the best results with a 100% patency rate at 5 years without pathological anastomotic intimal hyperplasia. Therefore, the heparinized biological graft anastomosed by laser could be the best option for the reconstruction of small vessels although these grafts might be clinically useful for small caliber grafts.     

Strength of microvascular anastomoses: comparison between the unilink anastomotic system and sutures

The Unilink system, a mechanical anastomotic device, was compared with standard suture techniques in terms of anastomotic strength under conditions of uniaxial loading. Twenty-five rabbits underwent Unilink and suture anastomosis of both carotid arteries and facial veins. Animals were sacrificed at 1 hour (five animals), 2 weeks (10 animals), and 16 weeks (10 animals), and all vessels were tested by constant loading in a material testing machine. The maximum load required to disrupt the anastomosis as well as the site of vessel failure were recorded. All 100 anastomoses were fully patent as evaluated by clinical testing. At 1 hour and 2 weeks, the Unilink arterial anastomoses were consistently and significantly stronger than the sutured anastomoses. At 16 weeks the sutured arterial anastomoses were significantly stronger than Unilink. The Unilink anastomoses, however, remained approximately 50% stronger than unoperated normal vessels. No statistical differences were observed in the strength of venous anastomoses at any of the intervals tested. There were no statistical differences in the sites of failure of the vessels under loading (i.e., at the anastomosis or proximal or distal to it) between the two techniques.     

New burst test method for comparing strengths of blood vessel repairs

An in vivo system was developed which allows researchers to determine the intraluminal pressures necessary to burst anastomosed blood vessels. Rat femoral arteries underwent standard microsurgical anastomoses and sham surgeries. After 6 min of leak-free blood flow, the vessels were ligated and cannulated with PE 50 tubing. The catheter was tied into position with 6–0 suture, constructing a water-tight balloon of tissue inclusive of the repair site around the tubing, then attached via a “Y” adapter to a pressure transducer with a digital readout and to a saline filled syringe in an infusion pump. The digital readout from the transducer accurately expressed the pressure on the anastomosis. The highest pressure recorded when the anastomosis ruptured was taken to be the anastomotic burst pressure. Mean burst pressure for 9 suture anastomoses was 326 mm mercury. All vessel burst pressures exceeded rat mean systolic pressure; 90% exceeded rat maximum systolic pressure. All sham surgeries failed to burst, even at pressures exceeding 1,500 mm Hg. The burst pressure test clearly provides researchers with a valid quantitative measure for in vivo comparison of the efficacies of various anastomotic techniques. © 1995 Wiley-Liss, Inc.     

Vertical mattress suture technique: an alternative vascular anastomosis

The objective of this study was to introduce the vertical mattress (VM) suture technique and compare its patency and postoperative healing with other commonly used suture techniques. Thirty-two Sprague-Dawley rats were randomly assigned to one of four suture techniques to be applied to both femoral arteries: continuous (C), interrupted (I), VM, and VM with flap (VMF) sutures. The operating time and the degree of postanastomotic leakage were recorded. The milking test was employed 5 and 15 minutes and 14 days after the operation to attain patency. Blood flow velocity was determined using ultrasonography at 1 hour and on days 1 and 14 postoperation. Rats then were sacrificed, and anastomotic lining tissues were harvested for histopathologic examination. Anastomoses by C and I were executed in 12.06 and 18.31 minutes. Modified suture techniques took longer to execute anastomosis (23.09 minutes for VM and 32.44 minutes for VMF). VM suture technique was superior to other suture techniques in terms of anastomotic leakage, quality of filling, and blood flow velocity. Also, absence of the luminal closure or constriction, intimal injury and hyperplasia, foreign body inflammation, and inversion were noted in histopathology. In conclusion, the VM suture technique could be considered for microvascular surgery.