末端對側壁血管接合術應用於自由皮瓣拯救手術－兩病例報告

End to Side Anastomosis to Internal Jugular Vein in Salvage Operations-Two Cases Report

徐偉凱(Wei-Kai Zhu) ； 白馨(Pai Hsin) ； 李芳輝(Fang-Hui Lee) ； 羅正興(Cheng-Hsing Lo)

《臺灣口腔顎面外科學會雜誌》 23卷4期 (2012/12) Pp. 264-277

https://doi.org/10.7104/TJOMS.201212.0264

摘要

自由皮瓣重建已是廣泛性口腔癌切除術後的標準術式，因為他具有很高的成功率。而血管的接合方式主要有末端對末端與末端對側壁這兩種方式。末端對側壁血管接合方式被部分學者慣於操作，他們認為它有幾個好處：一、不受到管徑不一致的影響，可於側壁上剪出與供區血管一致的口徑。二、供區血管配置自由度高，可自由選擇於內頸靜脈遠端或近端進行接合，以提供一無張力的靜脈配置。三、接於內頸靜脈成功率高，因為它靜脈回流強，呼吸時負壓等好處。本文將提出兩位病人：一位是於九年前初次口腔癌手術後又再度復發的病人，重建使用腓骨自由皮瓣與肩胸皮瓣，術後發生腓骨皮瓣靜脈血栓，使用末端對側壁血管接合方式成功拯救。另一位病人為接受雙自由皮瓣重建的口腔癌患者，術後橈側前臂自由皮瓣發生靜脈血栓，同樣使用末端對側壁血管接合方式成功拯救。本文將提供我們進行末端對側壁的接合技術，以提供給顯微手術醫師作為參考。

關鍵字

末端對側壁血管接合 ； 自由皮瓣重建

並列摘要

Free flap reconstruction applied in extensive oral squamous cell carcinoma ablation has been the standard procedure due to its high success rates. The-end to-end and end-to-side anastomosis technique are two different methods used by most microvascular surgeons. End-to-side anastomosis to the internal jugular vein preferred by some surgeons can be attributed to the following benefits: 1. to overcome the vessel size discrepancy- the side wall of the internal jugular vein can be tailored to match the caliber of the donor pedicles; 2. freely manage geometry of pedicles- we can choose the distal or proximal part of the internal jugular vein for end-to-side anastomosis to provide a tension-free geometry; 3. To achieve high success rates of anastomosis to internal jugular vein- the internal jugular vein, per se, tend to be clot-free owing to its high velocity and the pumping effect during respiratory inspiration. This paper presented two cases: The first case was a patient with an oral squamous cell carcinoma 9 years ago, having a second primary tumor in his oral cavity. After tumor ablation, the defects were reconstructed with fibula free flap and deltopectoral flap. The fibula free flap suffered from venous thrombosis postoperatively, and we successfully salvaged the flap using the end-to-side technique. The second case was a patient presenting with squamous cell carcinoma of right cheek and receiving double free flaps reconstruction. The radial forearm free flap had venous thrombosis problem, and we used the similar end-to-side technique and salvaged the flap. For this reason, we presented our end-to-side technique as a reference material for other microvascular surgeons.

並列關鍵字

end to side anastomosis ； free flap reconstruction