Cyanoacrylate 조직접착제를 이용한 미세혈관문합술의 연구

Abstract

[한글]

봉합사를 이용하여 혈관문합을 시행하는 전통적인 미세혈관문합 방법은 비교적 성공률이 높은 수술 방법으로 알려져 왔으나 봉합침에 의해 혈관 내막이 손상되고 수술시간이 길며 수술수기가 어려운 단점이 있다. 그리하여 혈관 내막의 손상을 줄이고 수술 조작이 간단하고 신속한 미세혈관문합 수술 방법을 찾고자 여러 방법들이 시도되었지만 만족할 만한 결과를 얻지 못하였다.

이에 본 연구는cyanoacrylate 조직접착제를 이용하여 혈관 문합을 더욱 효과적이며 성공적으로 시행할 수 있는 방법을 개발하고자 하였다. 성견 8마리의 양측 radial artery와 cephalic vein을 절단하고 양측 혈관 외막을 중첩 시킨 다음 외막의 표층에 필요한 최소량의 cyanoacrylate 조직접착제를 적용하여 미세혈관문합술을 시행 하였다. 미세혈관문합술 2시간 후와 4주 후에 문합 혈관을 채취하여 광학 현미경으로 관찰하여 다음과 같은 결과를 얻었다.

1. 미세혈관 문합 후 100%의 개존율을 보였다.

2. 미세혈관 문합 후 혈관내강의 협착, 혈전 또는 혈소판 응집현상으로 인한 혈관폐쇄는 없었다.

3. 미세혈관 문합 후 4주에서 혈관 내막과 중막의 연속성이 완전히 이루어졌다.

4.미세혈관 문합 후 4주에서 혈관 외막에 조직접착제가 잔존하였으며 이들 조직 접착제 주변으로 이물반응이 있었으나 혈관내막의 치유에 영향을 미치지 않았다.

[영문]

Conventional microvascular anastomosis using sutures is well-established and successful technique. However, it cause trauma to the vessel walls from passage of the suture needle, vessel narrowing and foreign body reaction, due to the presence of the suture material, thereby enhancing the risk of intravascular thrombosis. The technique is also tedious and time-consuming. In attempt to overcome these shortcomings, investigators have employed a variety of other anastomotic techniques, including mechanical devices ,laser welding, and tissue adhesives with biologic and non-biologic materials.

The idea of using cyanoacrylate adhesives for microsurgery is attractive, and there are many reports on the anastomosis of blood vessels with the use of cyanoacrylate adhesives. However, cyanoacrylate adhesives have been used as an auxillary after placing several stay sutures or telescoping one vessel into the other one. Although somewhat faster than conventional suture anastomoses, the forementioned techniques still require some suturing, which lead to time-consuming and vessel wall trauma.

The present study was designed to investigate the feasibility of microvascular anastomoses using a cyanoacrylate tissue adhesive. Eight mongrel dog were used in this study. The radial artery and cephalic vein were selected and transected. After the adventitias of the two vessel ends were overlapped, minimal amount of cyanoacrylate tissue adhesive was applied on the overlapped adventitias. For light microscopic evaluations of the anastomosed vessels, arterial and venous specimen was obtained two hours and 4 weeks later.

The followings are noted as results ;

1. Patency rate of the anastomosis was 100%.

2. The narrowing of lumen of the vessel and the formation of thrombosis were not found after anasotomosis.

3. The complete restoration of intimal continuity and medial healing were noted in 4 week following anastomosis.

4. Still remaining of cyanoacrylate on the overlapped adventitia was found in 4 week following anastomosis and foreign body reaction was noted around the cyanoacrylate adhesives. But this tissue reaction did not disturb the normal healing of the anastomotic site