微血管吻合器辅助游离组织瓣移植修复颌面部肿瘤术后缺损的临床应用  

Clinical application of free flaps which were transplanted to repair the postoperative defects of maxillofacial tumors with the aid of microvascular anastomotic

作　　者：明华伟[1] 袁宗毅[1] 张兴安[1] 贾佳欣 王华东[1] 陈方园 谭小尧[1] 何芸[2] MING Huawei;YUAN Zhongyi;ZHANG Xing'an;JIA Jiaxin;WANG Huadong;CHEN Fangyuan;TAN Xiaoyao;HE Yun(The Department of Oral and Maxillofacial Surgery,The Second Clinical Medical College of North Sichuan Medical College,Nanchong Central Hospital,Nanchong 637000,China)

机构地区：[1]川北医学院第二临床医学院,南充市中心医院口腔颌面外科,四川南充637000 [2]川北医学院第二临床医学院,南充市中心医院口腔科,四川南充637000

出　　处：《中国美容整形外科杂志》2024年第8期488-491,共4页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：南充市科学技术局市校科技战略合作项目(20SXQT0261)。

摘　　要：目的探讨游离组织瓣在颌面部肿瘤术后缺损修复中应用微血管吻合器吻合血管的临床效果.方法回顾性分析自2018年3月至2021年3月,南充市中心医院口腔颌面外科采用游离组织瓣修复118例颌面部肿瘤术后缺损患者,同期选择微血管吻合器辅助完成游离组织瓣血管吻合,记录微血管吻合器直径、血管吻合时长及吻合后即刻通畅率,术后随访组织瓣成活率.其中前臂皮瓣58例、股前外侧穿支皮瓣57例、腓骨瓣3例.结果118例患者均完成游离组织瓣移植修复,术中使用微血管吻合器234枚,其中233枚用于静脉吻合(3例为单静脉端侧吻合,其余115例均为双静脉端端吻合),吻合单根血管耗时为3.0~8.0 min,平均5.4 min;1枚用于动脉端端吻合,耗时12.0 min.所有借助微血管吻合器吻合后的血管即刻通畅率为100%.术后随访3个月,118例游离组织瓣成活117例,其中2例于术后第2天发生血管危象,经急诊探查抢救,1例组织瓣成活,另1例坏死后清创,改用胸大肌肌皮瓣修复创面.结论微血管吻合器辅助游离组织瓣移植修复颌面部肿瘤术后缺损,可明显缩短血管吻合时间,操作简便、快捷,吻合口质量较为可靠,是游离组织瓣血管吻合的一种理想选择.Objective To investigate the clinical effect of microvascular anastomosis with free tissue flap in the repair of postop-erative defects of maxillofacial tumors.Methods From March 2018 to March 2021,118 patients who suffered from maxillofacial tumors were selected from the Department of Oral and Maxillofacial Surgery in Nanchong Central Hospital the microvascular anastomotic was selected to assist the vascular anastomosis of free tissue flap during the operation,recorded microvascular stapling diameter,the vascu-lar anastomosis time and immediate patency rate after anastomosis,the postoperative survive rates of free tissue flap were evaluated.Fifty-eight forearm flaps,57 anterolateral femoral perforator flaps were included,and 3 fibular flaps were included.Results A total of 118 cases were repaired with free tissue flaps.Totally 234 microvascular anastomotics were used during the operation,233 microvascular anastomotics were used for venous anastomosis(3 patients received single-vein end-to-end anastomosis,while the remaining 115 patients received double-vein end-to-end anastomosis).The time of anastomosis of a single vessel was 3.0-8.0 min,with an average of 5.4 min.One was used for end-to-end arterial anastomosis and lasted 12 min.The immediate patency rates of all vessels after anastomosis with the aid of microvascular anastomats were 100%.Postoperative follow-up showed that 117 of 118 free tissue flaps survived,and 2 cases devel-oped vascular crisis on the second day after surgery.After emergency exploration and rescue,1 flap survived,and the other one was debrid-ed after necrosis,and the pectoralis major myocutaneous flap was used to repair the wound surface.Conclusion The microvascular anas-tomat which is used for vascular anastomosis of free tissue flap in the reconstruction of postoperative defects of maxillofacial tumors can sig-nificantly shorten the time of vascular anastomosis,the operation is simple and fast,and the quality of anastomosis is relatively reliable,so it is an ideal choice for the vascula

关 键 词：微血管吻合器 游离组织瓣 血管吻合 显微外科修复重建 

分 类 号：R739.81[医药卫生—肿瘤]