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題 名 | Bilateral Spatulated Y-Shaped Microvascular Anastomosis--A Practical Technique for Overcoming Vessel Size Discrepancies=顯微吻合技術克服口徑差異--利用兩血管側切開縫合併Y型血管吻合術 |
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作 者 | 張鳳書; 謝東穎; 沈彥廷; 張智豪; 黃書鴻; 李書欣; 張高評; 郭耀仁; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷 期 | 25:3 2016.09[民105.09] |
頁 次 | 頁196-203 |
分類號 | 416.45 |
關鍵詞 | 顯微手術; 血管口徑; 血管吻合; Vessel size; Mismatch; Discrepancy; Microsurgery; Anastomosis; Microvascular; |
語 文 | 英文(English) |
中文摘要 | 背景:顯微游離組織移植已經成為頭頸癌症切除後的最主要重建方式,然而捐贈端及接受端的血管口徑大小的差異,仍然是顯微手術中很大的挑戰。目的及目標:因此我們發展出一套有用的技術來解決血管口徑差異的問題:利用兩血管側切開縫合併Y型血管吻合術。材料及方法:手術技術說明如下:首先,如果顯微吻合手術中兩端的靜脈口徑差異大於兩倍,我們則可利用同是接受端的兩條口徑較小的血管,利用兩血管側切開並縫合來加大口徑,以達到足量的靜脈回流,兩條血管我們從側邊縱向的切開並縫合來加大整體口徑,然後口徑大小即可配合另一端的口徑,第一針將兩個小血管切口的尖端縫合,然後使用連續縫法來完成兩小血管管腔的合併,以達到較大的單一口徑,這樣由原本兩個小血管的管腔所形成新的大管腔,其口徑大小則接近需要吻合的另一端的血管口徑。九個頭頸部重建手術,我們使用此技術來完成靜脈吻合手術。結果:這技術施行於九位頭頸部的重建手術,包含6個前臂橈動脈皮瓣及3個大腿前外側皮瓣。受限於廣泛性的頸部淋巴清除手術,接受端的靜脈只剩下唯一大口徑的外頸靜脈。在所有的個案中其靜脈管徑大小差異均>1:2,故利用兩血管側切開縫合併Y型血管吻合術來克服此障礙。吻合成功率是100%,沒有任何靜脈吻合的失敗及皮辦血液循環的問題。結論“利用兩血管側切開縫合併Y型血管吻合術"可以在頭頸部完成血管口徑大小差異大於兩倍以上的血管吻合手術。 |
英文摘要 | Background: Microvascular free tissue transfer has become the most common option for reconstruction in head and neck cancer. However, size discrepancies between the donor and recipient vessels are still a challenge to overcome in the microvascular surgical field. Herein, we describe a useful technique for overcoming vascular-size mismatch through a "bilateral spatulated Y-shaped anastomosis" procedure. Materials and Methods: This surgical technique includes the preparation of two recipient veins or two small concomitant veins for drain outflow by bilateral spatulated side-to-side anastomoses when significant vessel discrepancy (≧1:2) is noted. The ends of two vessels with smaller diameters were longitudinally incised to increase the luminal circumference to match that of the opposing vessel. The first suture is placed at the apex of the incision on both sides of the smaller vessels, and then, the vasculoplasty is completed using interrupted sutures, which results in a single larger lumen. The two smaller vessels, which are now fused into one neo-lumen, possess a circumference similar to that of the opposite vessel for anastomosis. This technique was applied in nine patients for head and neck reconstruction. Results: The nine cases included six radial forearm flaps (RF flap) and three anterolateral thigh flaps (ALT flap). Recipient vein selection is limited due to radical neck dissection, leaving us only one large-caliber external jugular vein. This technique was used to overcome venous size discrepancies > 1:2 in all of our cases. The resulting anastomosis patency rate was 100%. No venous anastomosis failed or flap circulation was compromised. Conclusion: "Bilateral spatulated Y-shaped anastomosis" can be applied in head and neck cases with size discrepancies >50%. |
本系統中英文摘要資訊取自各篇刊載內容。