Before reading this article, we sincerely invite you to click "Follow", which is convenient for you to discuss and share, but also to share more professional health knowledge to escort your health, thank you for your support.
The 20th century was an era of rapid development of minimally invasive medicine, and the birth and development of microsurgery in this great era was an important milestone, bringing a new dawn to patients and their families.
As early as 1960, the United States first used a microscope to successfully anastomose small blood vessels of 1.6mm-3.2mm. Open the door to vascular anastomosis technology and lay a solid foundation for vascular anastomosis technology, from this time, the rapid progress of microanastomosis instruments and vascular anastomosis technology makes it possible to anastomosis smaller blood vessels and nerves, which is a great driving force for the development of microsurgery.
Vascular anastomosis technology is the basis of microsurgery and is widely used in various clinical disciplines, mainly involving flap transplantation, organ transplantation, vascular transplantation, traumatic tissue repair and other fields.
With the urgent demand for vascular anastomosis technology in various clinical fields, vascular anastomosis technology has been continuously improved. When the safety and practicality of microanastomosis have been confirmed by clinical practice, free flap tissue plays an important role in modern surgery, and is now widely used in related disciplines such as postoperative reconstruction of breast cancer, trauma reconstruction of head and neck and limbs.
Although vascular anastomosis has made great progress and is widely used in clinical practice. However, problems such as complicated vascular anastomosis operation, long surgical time, intimal injury, and microsurgeons need a lot of energy and time to train and practice, and need a long cycle of cultivation.
Even for highly qualified microsurgeons with many years of experience, anastomosis microscopic and small blood vessels is still difficult. With the continuous development of science, there are many methods of vascular anastomosis in the clinic, but all have their shortcomings.
People continue to explore in order to find a simple operation, small vascular damage, fast and convenient vascular anastomosis method. Manual suture anastomosis is still the "gold standard" for vascular anastomosis, and there are currently about 20 kinds of vascular anastomosis techniques that have been continuously innovated on the basis of manual anastomosis.
Commonly used clinics are: suture anastomosis, vascular anastomosis, adhesive anastomosis, laser vascular anastomosis and other categories. The research progress and application status of vascular anastomosis technology are introduced on several common anastomosis methods.
Vascular sutures are legal for kissing
Suture anastomosis is the earliest and most traditional vascular anastomosis method, and until now, manual suture anastomosis is still the "gold standard" for clinical vascular anastomosis. In the early days, people continued to improve stitching methods on the basis of manual suture anastomosis, mainly including: two-fixed-point or three-fixed-point intermittent suture, continuous suturing, mattress suturing, etc. As sutures continue to improve, the quality of vascular anastomosis improves.
However, it still cannot change the shortcomings of manual anastomosis that takes a long time, the vascular lining is easily damaged, the sutures are difficult to absorb, and the postoperative vascular narrowing. There are also high technical requirements for clinicians,
Before suturing, the two ends of the blood vessel should be free out of the appropriate length, and the caliber of the blood vessel, the thickness of the tube wall, the suture needle distance, the suture margin, the number of suture needles should be grasped when suturing, and the strength of the suture should be grasped to minimize the damage to the vascular lining. Therefore, a lot of time is required to strengthen the practice, which is difficult for clinicians who have a lot of work.
At present, manual anastomosis is mainly used in three ways: end-end anastomosis, end-lateral anastomosis and sleeve anastomosis. Although manual anastomosis of blood vessels has many shortcomings, such as cumbersome operation, heavy damage to the endovascular lining, long time, and high technical requirements for operators, etc.
However, because of its simple instrument, low cost and high success rate, it is suitable for various blood vessels with different diameters. At present, the traditional suture anastomosis is still the most clinically used vascular anastomosis method, and it is still the "gold standard" for vascular anastomosis.
Vascular anastomosis is legal
Traditional manual anastomosis is the earliest and most common method of vascular anastomosis in clinical practice, but it takes a long time, has great damage to the endovascular membrane, has high requirements for operation technology, and intraluminal sutures can lead to thrombosis. A new anastomosis method is urgently needed, and with the continuous development of medical level, microvascular stapler is widely used in clinical treatment.
Vascular anastomosis refers to a vascular anastomosis method that replaces or partially replaces sutures with a special vascular anastomosis device, which is easy to operate, time-consuming, and reduces intimal damage.
The earliest appearance of vascular anastomosis can be traced back to 1900, using annular mechanical anastomosis to fit blood vessels, this bold attempt, inspire people to continue to create new and improve vascular anastomosis devices, vascular anastomosis has been matured in clinical surgery. Although vascular stapler has been widely used in clinical practice, the use of vascular stapler still has certain limitations.
If there are specific requirements for the caliber of the blood vessels to be anastomosed, the anastomosis direction of the two broken ends must be maintained at 90 degrees, and the anastomosis vascular device is not toxic to the human body and also requires a certain length of blood vessels. Several kinds of staplers are more common in clinical practice, including magnetic tube method, anastomosis clamp method and needle loop method, which are more commonly used.
Magnetic tube method
As an emerging technical discipline, magnetic surgery is widely used in clinical disciplines.
Among them, the magnetic tube method is to use specially designed magnetic medical devices or equipment to complete the anastomosis of the broken end of blood vessels under the action of magnetic field force. Magnetic tube anastomosis has the advantages of fast anastomosis speed, simple operation and high patency rate.
This method is not affected by the direction of anastomosis vessels, and can be used in a variety of vascular anastomosis types, such as end-end, end-side and side-side anastomosis of blood vessels, etc., making the anastomosis process more convenient, can significantly shorten the operation time, shorten the ischemia reperfusion time of tissues or organs, reduce the incidence of vascular crisis, and reduce endovascular damage.
This technology has been successfully applied in clinical surgery, such as flap tissue transplantation, coronary artery bypass grafting, and organ transplantation, and has achieved satisfactory clinical results. Although the magnetic tube method is significantly better than the traditional manual suture method in terms of operation time, the damage to the endovascular membrane is significantly better.
However, it also has some disadvantages, such as magnetic materials are metal foreign bodies, which are easily corroded by body fluids in the body, have poor biocompatibility, and are prone to rejection. At the same time, the magnetic field generated by magnetic materials will also disturb some functions in the body, which will affect the normal working frequency of various pacemakers in the body and interfere with imaging-related examinations.
During surgical operations, magnetic materials will exert certain magnetic field forces on other surgical instruments, interfering with their normal operation. When multiple magnetically identical anastomosis materials appear in the body, they will attract each other, and a certain distance must be kept to relieve mutual attraction.
Although there are some disadvantages of magnetic tube anastomosis, it is still advisable to use magnetic field force to anastomose blood vessels. This method can significantly shorten the operation time, improve the patency rate, reduce complications and other advantages, in line with the development trend of microsurgery.
At present, although there are some defects, it is hoped that under people's continuous exploration, a vascular anastomosis device that is more in line with the structure of human vascular tissue has been developed, the device material is less toxic, and has good compatibility with human tissue, and can be naturally degraded in the body, and can be suitable for the anastomosis of blood vessels of various calibers.
Stomosis clamping method
Vascular anastomosis clipping belongs to the vascular anastomosis method of "non-penetrating vascular anastomosis technology", which reduces the damage to the vascular lining.
In 1992, the theory of vascular anastomosis and anastomosis was first proposed. Vascular anastomosis clips mainly include titanium alloy anastomosis clips, valgus forceps and stapler. During the anastomosis operation, the walls of the two broken ends of the blood vessels are evenly valgued and aligned with the valgus forceps, and then the buttons of the handle part of the stapler are pressed with appropriate force to make the two blood vessel broken end tissues fit closely.
The vascular clamp handle is retracted, and the anastomosis clamps the vascular wall when it changes from a "C" shape to an approximate "O" shape, and the above process is repeated repeatedly until the blood vessel is anastomosed at the broken end.
The biggest advantage of vascular snout is that the damage to the endovascular membrane is small, and there is no foreign body in the lumen, which reduces the probability of postoperative thrombosis in the lumen and reduces the operation time. However, this method also has certain defects, such as the clamping force is difficult to control, only suitable for arterial and venous anastomosis with thick blood vessel wall, foreign body residue in the body, poor tissue compatibility and other shortcomings.
Less applicable in clinical practice. Needle and ring method: Needle and ring anastomosis is the earliest mechanical anastomosis method, which is a more commonly used mechanical anastomosis method in clinical practice, and is more mature than other mechanical anastomosis methods.
The needle loop method was first invented in 1960. In 1962, the needle loop method was improved in material and operation method, and people gradually applied it to clinical surgery through continuous experimental improvement.
Today's anastomosis devices are more delicate, smaller and easier to operate. In clinical practice, the most used is the needle ring method, first the two broken ends of the anastomosis blood vessel are free out of the appropriate length, keep the lumen moist and smooth, rinse the lumen with heparin saline and remove congestion, and measure the size of the outer diameter of the broken end of the anastomosis vessel, and select the appropriate size microvascular stapler according to the measured vascular caliber results and anastomose.
This anastomosis method can significantly shorten the anastomosis time and reduce the damage of the endometrium, but there are still certain defects, such as the high cost of the stapler, the limited scope of blood vessels, and the difficulty of dissolving the anastomosis material.
At present, various vascular anastomosis devices have been invented at home and abroad and applied in clinical practice. Although there are certain deficiencies, it is hoped that with the continuous advancement of science and technology, a device suitable for vascular anastomosis can be developed.
Adhesive kisses legally
In recent years, with the continuous exploration of vascular anastomosis technology, surgeons have gradually become interested in the use and development of medical adhesives. At present, the most commonly used medical adhesives in clinical practice are cyanopropionate and fibrin glue, which have good tissue compatibility, low toxicity, easy absorption, and are often used to bond some smaller surgical incisions.
It was found that medical glue has adhesion, no sutures, and at the same time, adhesion has the effect of stopping bleeding, which can overcome the drawbacks of manual suturing, so the idea of anastomosing blood vessels with medical glue was born. At present, it has been confirmed through animal experiments that medical adhesive has the advantages of simple operation, no contact with the endovascular membrane, small damage to the endometrium, and hemostatic function.
However, the choice of medical glue is very strict, medical glue used in the body must first meet the characteristics of non-toxicity, good biological tissue compatibility, easy degradation, and secondly, good adhesion strength and durability in a certain period of time, adhesive use and easy to preserve, use and other characteristics.
Medical glue often requires lumen stents to be used together, and the stent should be non-toxic and easy to dissolve. Therefore, adhesive kiss legal shortcomings easy to block the lumen of the tube, poor alignment of the blood vessel wall, colloidal leakage can cause lumen closure and other shortcomings, with the continuous improvement, adhesive kiss law has gradually entered clinical application from animal experiments.
Laser vascular anastomosis
When science and technology continue to enter the medical field, medical technology improves rapidly. Laser technology is also widely used in clinical applications such as plastic surgery, surgery, ophthalmology and other departments, and at the end of the 70s, laser technology was first applied to vascular anastomosis.
Laser anastomosis refers to the use of laser energy to anastomosis vascular tissue. Laser anastomosis can significantly shorten the operation time, reduce the damage of the endometrium, improve the patency of blood vessels, reduce thrombosis, and there is no foreign body residue in the body. At present, there are mainly CO2 lasers, Ar ion lasers and laser diodes, etc., and the excited laser energy is used for vascular anastomosis.
The success or failure of laser vascular anastomosis mainly depends on laser wavelength, pulse width, energy density, action time and other parameters, and the appropriate size of laser energy can be selected to anastomosis the blood vessel.
If you choose a laser that does not match the vascular tissue to anastomosis the blood vessel, when the laser energy is too large, the vascular tissue will be damaged by excessive laser irradiation, and even the possibility of carbonization will appear, which will not be repaired, and the energy is too small to complete the anastomosis of the blood vessel. At the same time, laser vascular anastomosis has high requirements for the type of blood vessel.
Because different blood vessels have different vascular structures and different vessel wall thicknesses, different blood vessel layers require different intensities of lasers, and the required force is different.
It is difficult to find the right size laser energy, resulting in laser anastomosis vascular technology not widely used in clinical practice. With the continuous demand for non-invasive and minimally invasive diagnosis and treatment technology, even if laser vascular anastomosis technology is not fully mature, laser vascular anastomosis will not be given up to provide a minimally invasive treatment method for the clinic.
Vascular anastomosis is widely used in various clinical disciplines and has become one of the essential skills of surgeons. However, in the clinic, every medical technology needs to be mastered proficiently, a lot of experimental teaching and repeated training and practice are required, but in the tedious clinical work, it is not realistic to invest a lot of time to practice vascular anastomosis technology.
This has led to the emergence of a large number of new materials and technologies, and as the practicality and safety of various materials continue to be confirmed, it also promotes the development of vascular anastomosis technology. Find a anastomosis method that is simple to operate, has little damage to the vascular lining and has high patency rate.
However, in actual clinical work, vascular anastomosis is still dominated by manual suture anastomosis, which is difficult to operate, takes a long time, and has high technical requirements for the operator himself.
In order to solve this problem, different suture methods and suture tools have been continuously explored and improved clinically, but manual suture is still the main clinical practice.
The success of manual suture anastomosis mainly depends on the clinical experience and technical level of the operator, so surgeons need to invest a lot of time to improve their technical ability through repeated practice and training, and then need to continue to practice from long-term clinical work, accumulate experience, lessons to achieve a higher level of anastomosis.
With the continuous thirst of clinicians for new vascular anastomosis technology, the quality and speed of vascular anastomosis are continuously improved. Vascular anastomosis technology has gradually risen to a new level and has achieved some clinical success.
At present, vascular anastomosis methods that have been applied to clinical practice include vascular anastomosis, adhesive anastomosis, laser vascular anastomosis, tissue engineering blood vessels, etc., although these methods have certain shortcomings and are not widely used in clinical practice, but different vascular anastomosis methods still have some advantages in some aspects.
At present, a vascular anastomosis method has not been invented at home and abroad, which fully meets the anastomosis requirements of no damage to the vascular lining, simple operation, and high patency rate, which motivates us to continue to find new vascular anastomosis methods. More and better vascular anastomosis techniques will be applied to clinical surgery. With the continuous innovation of vascular anastomosis, vascular anastomosis technology will be simpler and faster, and the quality of anastomosis will gradually improve.