摘要目的 评价微血管吻合器在游离组织瓣修复头颈部缺损中的应用价值. 方法 回顾性分析2014年1月至2016年1月湖南省肿瘤医院743例患者共实施763块游离组织瓣重建修复头颈部缺损的临床资料.763块游离组织瓣,其中413块行手工缝合血管,350块使用微血管吻合器,血管吻合器的吻合方式包括静脉端端吻合159条,静脉端侧吻合190条,动脉端端吻合1条.对比手工缝合与血管吻合器在游离组织瓣中血管吻合时间、吻合口漏血率、静脉血栓发生率及组织瓣成活率的差异,评判血管吻合器的应用价值.同时分析血管吻合器组端端吻合和端侧吻合对静脉血栓和皮瓣成活的影响.采用SPSS软件19.0进行t检验和X2检验,P＜0.05为差异有统计学意义.结果 应用微血管吻合器进行血管吻合的时间[(4.43±0.51)min]明显短于手工吻合[(14.75±2.43)min,P＜0.05],吻合器和手工吻合的血管吻合口漏血率分别为0和9.7％(P＜0.05);术后静脉发生血栓率分别为1.15％和3.63％(P=0.02);组织瓣坏死率分别为0.57％和1.69％(P =0.15).应用血管吻合器时行静脉端端吻合和端侧吻合在血管吻合时间、静脉血栓发生率和组织瓣成活率差异均无统计学意义(P＞0.05). 结论 应用血管吻合器的能缩短血管吻合时间、降低吻合口漏血率、降低静脉血栓发生率和减少皮瓣坏死的风险,在游离组织瓣修复头颈部缺损的静脉吻合中有较大的应用价值.

abstractsObjective To evaluate the application of microvascular coupler device (MVCD) in the free-tissue flap transfer for head-and-neck defects reconstruction.Methods Its a retrospective study of the clinical data of 743 patients who received 763 free-tissue flap transfer for head and neck defects reconstruction in Hunan Cancer Hospital from January,2014 to January,2016.For microvascular anastomoses,413 were done manually (the manual group) and 350 done with MVCD (the MVCD group),of which the latter included end-to-end venous anastomosis in 159,endto-side venous anastomosis in 190 and end-to-end arterial anastomosis in 1.The time for anastomosis,rate of blood leakage from the anastomosis and venous thrombosis,and the survival rate of flaps were compared between the manual group and the MVCD group.The impacts of types of anastomosis of end-to-end vs end-to-side (both with MVCD),on the formation of venous thrombosis and survival of flaps were also recorded.The analysis was performed under t-test and chi-square test using SPSS software 19.0 with P ＜ 0.05 for differences with a statistical significance.Results Time for anastomosis was significantly shorter in the MVCD group (4.43±0.51min) than in the manual group (14.75± 2.43min,P＜0.05).The rates of anastomosis leakage were 0 in the MVCD group and 9.7％ in the manual group(P＜0.01),flap necrosis were 0.57％ and 1.69％ (P=0.15),the rate of venous thrombosis were 1.15％ and 3.63％(P=0.02),respectively.There was no significant difference in the time for anastomosis,the rate of venous thrombosis and the survival rate of flaps with end-to-end anastomosis and end-to-side anastomosis with MVCD.Conclusion The application of microvascular coupler device is valuable in the reconstruction of head-and-neck defects with free-tissue flaps because it can significantly shorten the time for anastomosis,decrease the ocurrence of anastomosis leakage and venous thrombosis,reduce the risk of flap failure.