褥式血管吻合在显微外科手术中的临床应用  

The clinical application of mattress vascular anastomosis in microsurgery

作　　者：孙法威 韩燕 田俊玥 杨振海 段亚南 张蕾 SUN Fawei;HAN Yan;TIAN Junyue(Department of Hand and Foot Surgery,The First People's Hospital of Pingyuan County,Dezhou,Shandong,253100,China)

机构地区：[1]平原县第一人民医院手足外科,山东德州253100 [2]平原县第一人民医院病理科,山东德州253100

出　　处：《实用手外科杂志》2022年第4期438-440,447,共4页Journal of Practical Hand Surgery

基　　金：山东省医药卫生科技发展计划项目(项目编号:2019WS026)。

摘　　要：目的探讨褥式血管吻合方法在显微外科手术中的应用。方法2016年6月-2021年12月,采取血管褥式吻合方法行断指再植及游离移植95例,其中断指再植75例95指,单指离断伤62例62指,多指离断伤13例33指,单人褥式缝合55例56指,双人褥式缝合20例39指;拇指Ⅱ°再造6例7指,单人褥式缝合3例3指,双人褥式缝合3例4指;游离皮瓣14例,其中单人褥式缝合9例,双人褥式缝合5例。结果术后断指再植75例95指,坏死3例4指,其中单人褥式缝合坏死2例2指,双人褥式缝合坏死1例2指,其中因感染坏死1指,严重挫伤坏死3指,成活率95.79%;拇指再造6例7指,全部成活;游离皮瓣14例全部成活。随访2~24个月,平均(16±5.6)个月,成活指体及皮瓣血运色泽良好。结论在显微外科手术中血管褥式缝合质量可靠,效果良好,尤其适用于单人褥式缝合吻接血管,值得临床推广应用。Objective To explore the application of mattress vascular anastomosis in microsurgery surgery.Methods From June 2016 to December 2021, a total of 95 cases of fingers replantation and free transplantation were performed by vascular mattress anastomosis in our hospital. Among them, a totlal of 75 cases of fingers replantation were 95 fingers. Among them, 62 cases were single severed finger, other13 cases were mutiple severed fingers including 33 fingers. Among them, single mattress suture was performed in 55 cases with 56 fingers, double mattress suture in 20 cases with 39 fingers. Ⅱ degree fingers reconstruction in 6 cases with 7 fingers, single mattress suture in 3 cases with 3 fingers, double mattress suture in 3 cases with 4 fingers. Free flap in 14 cases, including 9 cases of single mattress sutures and 5 case of double mattress sutures. Results Four fingers were necrotic in 75 cases of severed fingers replanted with 95 fingers, including 2 cases of single severed finger necrosis with single mattress suture, and 1 case with 2 fingers necrosis of double mattress suture. Among them, 1 finger was necrotic due to infection and3 fingers were necrotic due to severe contusion. The survival rate was 95.79%. Finger reconstruction was performed in 6 cases with 7 fingers, all of which survived, and 14 free flaps survived. The follow-up period was 2-24 months, with an average of(16 ±5.6) months. Survival fingers and flaps showed good revascularization. Conclusion Vascular mattress suture is of reliable quality and good effect in microsurgery.

关 键 词：褥式缝合 血管吻合 断指再植 手指再造 皮瓣 显微外科手术 

分 类 号：R658.1[医药卫生—外科学]