显微外科手术血管处理的经验教训

1978年至1986年6月,共行各种显微血管手术84例,成功77例(91.67％),失败7例(8.33％)。手术期间发生血管损伤、痉挛、栓塞、吻合质量不好而重新吻合等共14例次。术后早期(48小时内)发生血循环危象13例次。本组共发生动脉损伤2例,动脉栓塞6例,静脉栓塞8例,血肿6例。其中3例在术中及时处理,5例经术后及时检查而使皮瓣获得挽救。我们体会,重视显微外科解剖,避免术中失误,正确判断受区血管质量,注意静脉回流通畅,识别血肿危象,及时发现、及时探查,大部分手术都会取得成功。

EXPERIENCE AND LESSONS LEARNED IN THE HANDLING OF BIOOD VESSELS IN MICROSURGERY

From January 1978 to June 1986, 84 free flap transplantations were performed, in which 77 were successful (91.?%)and 7 failures(8.3%). The experiences and lessons obtained were presented in this paper. Fourteen instances of vessel injury, spasm, thrombosis, and unsatisfactory anastomosis occurred during the operation, necessitating re-anastomosis. Within 48 hours after an operation, vascular crisis occurred in 13 cases. Altogether, there were 2 cases of arterial injury, 6 cases of arterial thrombosis, 8 cases of venous thrombosis and 6 cases of heamatoma in our 'series. In 3 cases, the faults were corrected during the operation, and in 5 cases they were corrected in the postoperative period. All these 8 flaps survived. It is our belief that careful study of microvascular anatomy, avoid technical errors during the operation better assessment of the quality of the anastomosing vessels, maintain carefully the patency of the veins, early recognition of vascular crisis, and early exploration of the anastomosed vessels when vascular crisis occurs are important factors to assure a successful result in free flap transplantation.