低エネルギーNd-YAGレーザーを用いた無縫合微小血管吻合法

Sutureless Method of Micro-vascular Anastomosis with Use of Low Energy Nd-YAG Laser

I．緒言

　内径が3mm以下の微小血管吻合は，脳神経外科（たとえば，EC-IC bypass）^15,21-23）・形成外科（皮弁移植）^17）・整形外科（切断手指の再建）^6）などの広い領域で用いられている．従来臨床では，microsurgical techniqueを利用した手縫い法だけが行われている．しかし，手縫い法では，技術の巧拙が吻合の開存性に決定的な影響を与えるため，特に熟練を要さない無縫合微小血管吻合法（sutureless micro-vascular anastomosis）が幾つか試みられてきた^{5,11,12,20）}．このような吻合法を臨床的に用いるためには，確実性や安全性などの点で若干の問題が未解決であった^9）．

　この問題を克服するために，Nd-YAGレーザーとpoval splintによる無縫合微小血管吻合法を試行して好結果を得たので報告する．

Sutureless end-to-end anastomosis of rat common carotid artery was carried out, low energy Nd-YAG laser being used thereby. An intraluminal-intervascular splint, made of water-soluble poval, was used for pre-cise adaptation of the intimas. Neither stay suture nor glue was required.

The patency rate of the anastomosed vessels, 24 hours after operation, was as high as 91%. The vessels were confirmed to be likewise patent on the 7th and30th postoperative day. Complications such as pseudo-aneurysm formation or stenotic change, were negligible.