游离股前外侧皮瓣血管吻合技术问题

发布时间：2018-04-24 23:16

本文选题：游离 + 股前外侧皮瓣　；参考：《吉林大学》2015年硕士论文

【摘要】：目的总结我组游离股前外侧皮瓣手术，探讨验证更加合理的术中处理方式。方法搜集整理我组在2013年10月-2014年6月期间所完成的37例游离股前外侧皮瓣手术，对成活情况、探查因素与术中各类因素进行统计分析，研究其之间的关联性。结果本组37例病例中，血管吻合方法(共76例)：端端吻合组通畅例数70例，血栓形成3例;端侧吻合组对应数据为2例，0例；静脉移植1例，1例通畅。统计分析后P=0.196，无统计学差异。皮瓣血管蒂夹闭情况(共33例)：夹闭血管蒂组通畅3例，血栓形成0例；未夹闭血管蒂组通畅26例，血栓形成4例。统计分析P=0.570，无统计学差异。吻合口冲洗液成分(共37例)：肝素加生理盐水组通畅7例，血栓形成0例；生理盐水组通畅26例，血栓形成4例。统计分析P=0.570，组间无显著性差异。术中吻合口出现纤维蛋白(37例)：出现纤维蛋白组血管通畅0例，血栓形成4例；未出现纤维蛋白血管组通畅33例，血栓形成0例。统计分析P＜0.05，存在统计学差异。本次研究组皮瓣术后探查率8.11%,符合国际标准9.9%;皮瓣术后14天成活率91.89%。探查成功率为0，与皮瓣探查时机过晚有关。1例术后17天出现迟发性坏死结论本次研究结果表明，血管吻合方法与皮瓣术后通畅率无相关性，但端侧吻合及静脉移植技术仍是减少供区血管等损伤、处理术中供受区矛盾等棘手问题的关键技术。是否夹闭血管断端及是否应用肝素盐水对皮瓣术后探查率无显著影响。术中血管吻合口出现纤维蛋白与术后皮瓣探查率密切相关。此时处理方法应是全身应用肝素，，以对抗血液中的凝血活酶。
[Abstract]:Purpose To summarize the operation of free anterolateral thigh flap in our group and to discuss the more reasonable intraoperative management. Method 37 cases of free anterolateral femoral flap from October 2013 to June 2014 were collected and analyzed. Result Among the 37 cases, vascular anastomosis was performed in 76 cases (70 cases in end-to-end anastomosis group, 3 cases in thrombus formation, 2 cases in end-to-side anastomosis group and 1 case in vein transplantation group). After statistical analysis, there was no statistical difference (P < 0. 196). The vascular pedicle occlusion of the flap (33 cases) included 3 cases of patency and 0 cases of thrombosis in clipping pedicle group, 26 cases of unclipped vascular pedicle group and 4 cases of thrombus formation. There was no statistical difference between the two groups. The composition of anastomotic flushing fluid (37 cases): heparin + normal saline group (7 cases), thrombus formation (0 cases), saline group (26 cases) patency, thrombosis (4 cases). Statistical analysis showed that there was no significant difference between the two groups. There were 37 cases of fibrin fibronectasis in the anastomotic stoma, 0 cases in fibrin group, 4 cases in thrombus formation, 33 cases in fibrin group and 0 case in thrombus formation. Statistical analysis P < 0.05, there was a statistical difference. The exploratory rate of the skin flap in the study group was 8.11, which was in line with the international standard of 9.9.The survival rate of the flap was 91.8914 days after operation. The successful rate of exploration was 0. 1 cases had delayed necrosis 17 days after operation. Conclusion The results showed that there was no correlation between vascular anastomosis and patency rate after flap operation, but end-to-side anastomosis and vein transplantation were still the key techniques to reduce the injury of donor vessels and to deal with the intractable problems such as contradiction of donor area during operation. There was no significant effect on the exploration rate after flap operation by clamping the end of the vessel and using heparin saline. The appearance of fibrin in vascular anastomosis during operation is closely related to the exploration rate of skin flap after operation. Heparin should be used throughout the body to combat thromboplastin in the blood.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R622

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