Mechanical Dilation With a Nylon Monofilament for 0.1-mm Anastomoses
Mechanical Dilation With a Nylon Monofilament for 0.1-mm Anastomoses
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DOI：
10.1097/sap.0000000000001632
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发表时间：
2019-02-01
影响因子：
1.5
通讯作者：
Harima, Mitsunobu
中科院分区：
文献类型：
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作者：
Yoshida, Shuhei;Koshima, Isao;Harima, Mitsunobu
尽管超显微外科技术取得了进步，但吻合直径小于0.2 mm的血管的能力仍然有限。造成这种限制的原因之一是，目前可用的扩张方法，如将微钳尖端插入管腔或局部应用血管扩张剂，如盐酸罂粟碱或木卡因喷雾，在非常小的血管中无效。为了克服这个问题，我们开发了一种方法，将尼龙单丝放置在血管腔内作为扩张剂。使用这种方法，在插入较大的尼龙单丝作为扩张剂之前，将较小的尼龙单丝插入血管作为导向。在较小的引导单丝插入后，插入另一个单丝进行扩张要容易得多，即使它是一个较大的单丝。使用这种方法，即使直径小于0.1 mm的血管也可以扩张到大于0.2 mm。扩张单丝也可作为血管内支架用于吻合。我们发现，使用这种方法可以吻合直径小于0.1 mm的血管。根据我们的经验，即时通畅率是100%。我们相信尼龙单丝的机械扩张对超显微手术甚至超显微手术都有帮助。
Despite advances in supermicrosurgical techniques, the ability to anastomose vessels with a diameter of less than 0.2 mm remains limited. One of the reasons for this limitation is that the dilation methods currently available, such as inserting the tip of a microforceps into the lumen or topical application of a vasodilator such as papaverine hydrochloride or xylocaine spray, are not effective in very small vessels. To overcome this problem, we have developed a method whereby nylon monofilaments are placed inside the vessel lumen to act as a dilator. Using this method, a smaller nylon monofilament is inserted into the vessel as a guide before inserting a larger nylon monofilament as a dilator. After the smaller guide monofilament has been inserted, it is then much easier to insert another monofilament for dilation, even if it is a larger one. Using this method, even a vessel with a diameter of less than 0.1 mm could be dilated to greater than 0.2 mm. The dilator monofilament can also be used as an intravascular stent in the anastomosis. We have found that anastomosis of vessels with a diameter of less than 0.1 mm is possible using this method. In our experience, the immediate patency rate has been 100%. We believe mechanical dilation with a nylon monofilament is helpful for supermicrosurgery and even ultramicrosurgery.