两种血管吻合方式对游离组织瓣修复口腔颌面部缺损中皮瓣成活的影响

目的比较国产73-Ⅱ型血管套接器与普通血管缝合两种血管吻合方式对游离组织瓣修复口腔颌面部缺损中皮瓣成活的影响。方法根据不同的血管吻合方式将2005年10月至2012年1月间本院63例应用游离组织瓣修复口腔颌面部缺损的患者分为两组,血管套接组（n=32）修复时采用国产73-Ⅱ型血管套接器吻合动脉及静脉,普通血管缝合组（n=31）采用血管缝线吻合血管,比较两组病例血管吻合时间,术后皮瓣危象发生率、皮瓣成活率,以及患者面部外形、面部功能恢复情况。结果血管套接组、普通血管缝合组血管吻合时间分别为（15.66±8.76）分钟、（65.55±15.14）分钟,两组吻合时间有统计学差异（P〈0.05）。两组共移植组织瓣63例,术后发生皮瓣危象3例,成活61例,皮瓣危象发生率4.76%,总成活率为96.83%。血管套接组移植游离组织瓣32例,术后发生皮瓣危象1例、成活31例,皮瓣危象发生率3.13%、成活率96.88%;普通血管缝合组移植游离组织瓣31例,术后发生皮瓣危象2例、成活30例,皮瓣危象发生率6.45%、成活率96.77%。两组术后皮瓣危象发生率、皮瓣成活率均无显著差异（P〉0.05）。所有患者的创口均一期愈合。所有患者面部外形恢复良好、舌体运动、咬合关系及吞咽功能基本正常。结论游离组织瓣移植修复口腔颌面部缺损安全有效,患者面部外形、功能恢复满意。术中血管套接和普通缝合吻合血管的方法,术后皮瓣危象发生率和皮瓣成活率基本相同,但血管套接法吻合速度快、易于掌握,临床上需根据具体病情,结合患者自身经济条件进行选择。

The effect of two vascular anastomosis methods on free flap survival in instant reconstruction for oral and maxillofacial defect

Objective %To compare the effect of two vascular anastomosis methods on free flap survival in instant reconstruction for oral and maxillofacial defect.Methods Reconstruction with free flaps was performed in patients with oral and maxillofacial defect from October 2005 to March 2011 in our hospital.Two methods of vascular anastomosis were applied in reconstruction： ① vascular anastomosis with Chinese-made 73-Ⅱ vascular anastomosis device,② vascular anastomosis with vascular suture.The vascular anastomosis time,incidence of flap crisis,survival of free flaps,patients＇ appearance and functional recovery were observed and compared between the two groups.Results The vascular anastomosis time in vascular anastomosis device and vascular suture group were（15.66±8.76）min,（65.55±15.14）min respectively,with significant statistical difference（P0.05）.There were 63 free flaps in total,flap crisis occurred in 3 cases and 61 flaps survived well.Incidence of flap crisis and survival rate of free flaps was 4.76%,96.83% respectively in all patients,3.13%,96.88% in vascular anastomosis device group,and 6.45%,96.77% in vascular suture group.There was no significant statistical difference in incidence of flap crisis and survival rate of free flaps between the two groups（P0.05）.All patients had the wound healing of the first intention.Patients＇ appearance and functional also recovered well.Conclusion Instant reconstruction with free flaps is safe and effective for oral and maxillofacial defect.Vascular anastomosis device is superior to vascular suture in shortening anastomosis time,but not in reducing occurrence of flap crisis and increasing survival rate of free flaps.Choice is depending on disease and patients＇ economic conditions.