Homograft replacement of the aortic valve
Homograft replacement of the aortic valve
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主动脉瓣同种移植置换术
DOI：
10.1002/bjs.1800541011
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发表时间：
1967
影响因子：
9.6
通讯作者：
D. Ross
中科院分区：
文献类型：
--
作者：
D. Ross
与小血管手术相关的技术困难在于尺寸和准确性。不准确很可能导致缝合线变窄或不规则，进而导致血栓形成。尺寸问题可以通过光学放大来解决，而精度问题可以通过使用精密仪器和各种机械技术来解决。吻合血管的缝合线细至0.7毫米左右。可以使用带有细单丝尼龙的眼科和珠宝商仪器。最好是在两根偏心放置的缝合线之后进行间断缝合。缝合方法可靠，但需要练习并且速度慢。订书机速度快但复杂；大多数的尺寸下限为 1.5 毫米。尽管其中一种衬套尺寸为 1.0 毫米。 Nakayama 使用的尖刺环比订书机更简单且速度更快，但尺寸限制较低，为 2.0 毫米。 Blakemore-Lord 袖口结扎技术快速而简单，但可能会在血管腔内留下一些“台阶”，并且肯定会在血管周围留下坚硬的管子。这些因素容易在3.0毫米以下的血管中产生血栓。粘合剂和电附着很有前景，但缺乏拉伸强度。粘合剂还会引起局部组织反应。在研究实验室，这些技术使小动物的器官移植成为可能。特别是，各个中心正在使用近交系大鼠研究肾移植的免疫学。在东格林斯特德维多利亚女王医院的金发实验室，正在利用肾动脉和静脉的端到端缝合对大鼠进行同种肾脏移植。在临床领域，许多中心都有报道用肠移植代替颈段食管。断指再植也已实现。
THE technical difficulties associated with small bloodvessel surgery are those of size and accuracy. Inaccuracy may well lead to narrowing or irregularity of the suture line with subsequent thrombosis. The problem of size may be solved by optical magnification, and that of accuracy by the use of fine instruments and by various mechanical techniques. Suture anastomosis of vessels down to about 0.7 mm. is possible using ophthalmic and jewellers’ instruments with fine monofilament nylon. Interrupted sutures following two eccentrically-placed stay sutures are best. Suture methods are reliable, but require practice and are slow. Staplers are quick but complex; most have a lower size limit of 1.5 mm. although one is available with a bushing size of 1.0 mm. Spiked rings as used by Nakayama are simpler than staplers and are quick, but have a lower size limit of 2.0 mm. The Blakemore-Lord cuff ligature technique is quick and simple but may leave some ‘step’ in the vessel lumen, and certainly leaves a rigid tube around the vessel. These factors tend to produce thrombosis in vessels under 3.0 mm. Adhesives and electrocoaption are promising but lack tensile strength. Adhesives also cause local tissue reaction. In the Research Laboratory, organ transplantation in the small animal has been made possible by these techniques. In particular, the immunology of kidney transplantation is being studied in various centres using inbred strains of rats. In the Blond Laboratories at the Queen Victoria Hospital at East Grinstead, kidney homotransplantation is being performed in the rat using end-to-end suture of renal artery and vein. In the clinical field, transplantation of intestine to replace cervical oesophagus has been reported from many centres. Replantation of amputated digits has also been achieved.