Development of an anastomotic device for distal anastomosis to achieve marked improvement of total arch replacement

[目的]主动脉弓瘤的移植物置换术要取得显著效果，必须在短时间内完成无出血的远端吻合术。我们研制了一种用于远端吻合的吻合器，并进行了基础实验以证实其有效性。[方法]该吻合器具有便于床垫缝合的机构。使用牛胸主动脉和移植物(外径分别为20 mm和26 mm)。主动脉外侧使用ePTFE毛毯。缝合针长9.0 mm，缝线采用直缝。[结果]1.腹主动脉壁厚度及交针的确定性：虽然吻合器交针准确，但当腹主动脉壁厚度达到4.6 mm或以上时，仍有一定困难。2.相邻床垫缝合距离：2.0 mm时，发现相邻床垫缝合间隙，注水试验发现吻合口渗漏。在1.0 mm和1.0 mm重叠的情况下，相邻床层缝合之间未见穿透间隙。3.吻合器的针距：当针距为5.0 mm时，移针机构没有问题，床垫缝合线之间也没有间隙。当针间距为7.5 mm时，由于主动脉曲度和组织硬度的影响，针的弯曲和交接机制有时会受到干扰。当相邻的床垫缝合线没有重叠时，床垫缝合线之间会产生间隙。[结论]在针距为5.0 mm、相邻床垫缝合间隔为1.0 mm的条件下，本研究所研制的吻合器具有一定的临床应用价值。

[Purpose]To achieve marked improvement of graft replacement for aortic arch aneurysm, distal anastomosis must be performed without hemorrhage and in a short time. We developed an anastomotic device for distal anastomosis and conducted a basic experiment to confirm its efficacy. [Methods]The anastomotic device has a mechanism to facilitate mattress sutures. Bovine thoracic aorta and grafts (20 mm and 26 mm in outer diameter) were used. EPTFE felts were used for the outer side of the aorta. The suture needle was 9.0 mm in length and suture threads with straight stitches were used. [Results]1.Thickness of the aortic wall and the certainty of handing over of the needle : Although the needle was handed over accurately by the anastomotic device up to aortic wall thickness of 4.6 mm, difficulties were encountered in some cases with wall thicknesses of 4.8 mm or more. 2.Distance between adjacent mattress sutures : In the case of 2.0 mm, a space between adjacent mattress sutures was found and leakage from the anastomosis site was found in water infusion test. In the cases of 1.0 mm and of 1.0 mm overlap, no penetrating space was found between adjacent mattress sutures. 3.Inter-needle distance of the anastomotic device : With the inter-needle distance of 5.0 mm, there was no problem in the mechanism of needle handing over and no spaces were found between the mattress sutures. With an inter-needle distance of 7.5 mm, the needle bent and the handing over mechanism was disturbed in some cases due to the aortic curvature face and the hardness of the tissues. When there was no overlap of adjacent mattress sutures, spaces were produced between the mattress sutures themselves. [Conclusions]With an inter-needle distance of 5.0 mm and adjacent mattress suture interval of 1.0 mm, the development of anastomotic device in the present study suggested that a clinically useful anastomotic device could be made in the future.