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目的总结血管化自体颌下腺游离移植治疗角结膜干燥症的血管处理方法。方法对1999年8月至2004年4月完成的68例血管化自体颌下腺游离移植的血管处理作回顾性研究,分析受区和供区的血管、术后血管危象的发生和处理以及腺体的成活情况。结果68例游离颌下腺移植的供区和受区动脉均为颌外动脉与颞浅动脉,所用供区静脉中,面前静脉55例,颌外动脉伴行静脉12例,腺门静脉1例;所用受区静脉中,62例为颞浅静脉,1例为颞深静脉,5例经头静脉桥接后,回流至颈外静脉或颈内静脉的属支。术后10例出现血管危象,其中9例静脉危象,1例动脉危象,1例静脉危象经抢救腺体获得成活,本组移植腺体的成活率为86·8%(59/68)。结论血管化自体颌下腺移植的静脉变异较大,应根据每一病例的具体特点作出相应的处理,其中以颌外动脉伴行动脉与颞浅静脉的吻合最为可靠,显微镜下的血管吻合有助于降低术后血管危象的发生率,提高移植腺体的成活率。
Objective To summarize the methods of vascular treatment of autonomic submandibular gland graft for the treatment of keratoconjunctivitis xerophthalmia. Methods A retrospective study was performed on the vascular treatment of 68 patients with vascularized autologous submandibular gland transplantation from August 1999 to April 2004. The blood vessels of the affected area and donor area, the occurrence and management of postoperative vascular crisis, The survival of the situation. Results 68 cases of free submandibular gland transplantation for the donor area and the affected area were the external arteries and superficial temporal arteries, the donor area for venous anterior, veins in 55 cases, 12 cases of external carotid artery accompanying vein, portal vein in 1 case; In the regional veins, 62 cases were superficial temporal veins and 1 case was deep temporal veins. Five cases were bridged through the cephalic vein and returned to the branches of the external jugular vein or internal jugular vein. After operation, vascular crisis occurred in 10 cases, of which 9 cases of venous crisis, 1 case of arterial crisis, 1 case of venous crisis survived by the rescue gland, the graft survival rate of 86.8% (59 / 68). Conclusion Vascular autograft submandibular gland transplantation varicose veins larger should be based on the specific characteristics of each case to make the appropriate treatment, of which the external carotid artery accompanying arteries and superficial temporal veins of the most reliable anastomosis, microscopic vascular anastomosis contribute to Reduce the incidence of postoperative vascular crisis and improve the survival rate of transplanted glands.