下颌下腺游离移植中的供区和受区静脉的选择  

Management of donor and recipient veins in the vascularied autogeneous submandibular gland transfer

作　　者：廖贵清[1] 张思恩[1] 苏宇雄[1] 郑广森[1] 梁玉洁[1] 

机构地区：[1]中山大学附属口腔医院口腔颌面外科,广州510055

出　　处：《中华显微外科杂志》2014年第5期440-443,共4页Chinese Journal of Microsurgery

基　　金：广东省科技计划项目（20128031800036）

摘　　要：目的针对自体下颌下腺血管化游离移植治疗重症角结膜干燥症患者，在总结外科经验的基础上，分析其供、受区静脉特征，探讨选择不同回流静脉的手术方法。方法2002年6月至2013年6月，对48例（52侧）重症干眼症患者行自体下颌下腺移植，治疗角、结膜干燥症。手术中，先探查受区动、静脉，然后制备同侧下颌下腺供移植。制备过程中，重点观察静脉的特征，选择合适的回流静脉。结果48例（52侧）移植腺体，成活45例（49侧）。供体静脉选用面前静脉者39侧，颌外动脉伴行静脉12侧，腺门静脉1侧。受区静脉以颞浅静脉为主，共41侧，颞深静脉6侧，5侧以静脉的搭桥方式吻合于颈部。5例移植腺体出现静脉危象，重吻静脉后，2例腺体抢救成功。术后经7～144个月观察随访，患者角结膜干燥症状明显改善，获得良好的临床疗效。结论自体下颌下腺血管化游离移植治疗重症角结膜干燥症的手术中，供体静脉可选用面前静脉者、颌外动脉伴行静脉及腺门静脉，受区静脉以颞浅静脉为主，也可选择颞深静脉及静脉搭桥等方式。Objective To discuss the management and selection of donor and recipient veins in the transfer of vascularied autogeneous submandibular gland （SMG）. Methods The SMGs of 48 patients with severe keratoconjunctivitis were transfered to the temporal region by microsurgcry from June, 2002 to June, 2013. The secreted saliva was used as the substitute of tear. Donor and accepting- site vessels, vessels crisis and managements, survival of grafts were retrospectively analysed. Results Transplantation succeeded in 45 patients and failed in 3. For donor veins, 39 were facial veins, 12 were venae comitantes of facial artery, 1 was vein near the duct. For revipient veins, 41 were superficial temporary veins, 6 were deep temporary veins and 5 were veins in the upper neck. For revipient artery, except superficial temporary artery, deep temporary artery was also a good selection. After surgery, 2/5 venous crisis cases were rescued by reanastomosising veins. TC99m examination suggested that the 49 TSMGs were survived, and the ducts were unobstructed. Follow up lasted for 6 months to 10 years, the symptoms of photophobia and anemophobia were alleviated, the symptoms of corneal xerosis disappeared. Good clinical efficacy was obtained after transplantion. Conclusion During SMGs transplantion, facial veins, venae comitantes of facial artery or vein near the duct can be used for donor vein. For recipient veins, except the superficial temporary veins as major, deep temporary veins or veins in the upper neck is also a secection. Correct selection and microsurgical management of donor and revipient veins are keys to successful SMGs transplantion.

关 键 词：下颌下腺 移植 角结膜炎 静脉 

分 类 号：R782[医药卫生—口腔医学]