The Experimental Study Of Effective Vascular Pedicle Extention In Vaginoplasty Via Ileum Transplantation

With vascular pedicle ileum transplantation has been applied in various surgical replacement surgery, such as vaginal forming, ureteral forming etc. Especially with vascular pedicle of vaginal graft conduit angioplasty clinical applications has achieved satisfactory results. For vaginal graft conduit for recycling provides good cavity hole lining. Surgical need for selecting, transfer ileum anatomy, from the back of the blind 20cm ileum most near the pelvic cavity, transfer of bowel is low, but in the film position does not affect blood supply situation will be transplanted into artificially vaginal bowel, and near the abdominal wall, easy separation, the former can be selected in this long approximately 15-18cm have independent and vein of supply, and will not affect the ileum nearby the blood supply, the ileum distal ileum, colic arterial supply by, by the rest of the proximal ileum ileum artery supplies. Bowel mesenteric vessels for vagina is taking a period of the vagina technology transfer reengineering bowel mesenteric vessels, which influence vascular pedicle length and the important factors to. The superior mesenteric artery ileum artery from within, the mesenteric, finally to branch arcade straight artery of membrane margin into the small intestines. The mesenteric vascular bow in the rich in different positions in guarantee ileum of blood supply, make intestines evenly into the blood. The superior mesenteric artery from the left side, a number of empty, empty, ileum ileum artery arteries, small intestine range from the jejunum inchlong piece of arcade ileum appears to end by less than to appear, gradually reduce the trend.Clinically, in part, the patient angioplasty vagina especially sex-change surgery (male and female sexual deformities)-patients because of pelvic relatively narrow, male, mesenteric force, to a certain extent influence the bowel transplantation is down, or cause to shrink, recycling within the vagina operation effect. In the improvement of operation, transplantation, bowel blood relationship and effective arcade traffic has fine in the blood supply range, cannot satisfy the need surgery. Especially in recent years, with the ileum to replace organ transplantation and ileum itself transplant at home and abroad to empty, extensive, ileum blood supply material puts forward higher, more accurate and more comprehensive requirement. Based on the experiment of blood vessels traffic ileum bow to truncate the different characteristics, classification of the branch, blood vessels observation bowel characteristics of blood vessels, whether can ileum truncated part can still be safeguard branch after the blood supply of the bowel transplantation. This method of research at home and abroad, the dog has yet to experimental basis for such big animal experiments, pigs, and also not established model for replacement period, and histological change reported loops.Rabbit intestinal developed, ileum vascular bow for grade 3-4, and the human body, combined with the existing conditions similar to choose a common rabbit experimental animals. This experiment was established in different branches of vascular ligation ileum model based on animal experiments, and the interception retained vascular pedicle count bowel length divided into two kinds, from 1 to 3 ileum vascular gradually establish different methods, models and dynamic real-time observation transplantation bowel live and unobstructed. Under the microscope and intestinal tissue, and morphological changes histopathologic conclusion. At the same time, according to the different vessels, ligation that different bowel to increase the perineum pull in different length measurement, data, and strict in comparative study does not affect blood supply under the premise of vascular pedicle may extend the maximum distance. This experiment from animal experiments discusses ileum blood supply characteristics and vascular pedicle method to extend to improve clinical surgery to provide the basis.Objective:To study the different branches of vascular ligation ileum model, animal experiment and real-time dynamic observations transplant bowel live and unobstructed, from the perspectives of animal experiments ileum blood supply characteristics and vascular pedicle method to extend to improve clinical surgery to provide the basis,Methods:24 rabbits,2-2.5 kg weight, then divided into groups, single and double tilly tilly tilly, single group A, B and C group, A, B and C of the group for the control group. Double Wendy group includes D, E, F, D, E of the group, the group F (control group). Anesthesia, fixed, skin, incision selection etc, and the same for transplantation of vascular pedicle bowel with different group branch ligation retained intact transplantation of vascular pedicle bowel bow, instant observation transplant bowel, and blood in abdomen,7 days after the dynamic observations made fistula organization's survival situation. Finally the end made fistula (take) tissue transplant bowel end connection lines, read the dyeing pathological findings.Results:The bowel measurement data includes a complete blood vessels, clipping length of bowel bow to 6.5 0.4cm, interception±contains two complete intestinal length of vascular bow about 0.5cm 1.35±.A group of transplant bowel tensile extension length for downward 3.4±0.3cm, group B transplant bowel tensile extension length for downward 2.7±0.3 cm, group D transplant bowel tensile extension length for downward 6.2±0.3 cm, group E transplant bowel tensile extension length for downward 4.0±0.5cm. Bowel blood instant observation:single vascular pedicle group:after 30 minutes, ligation animal intestines period without obvious change color, the color, the overall bowel ruddy methods side bowel terminal small vessel pulsations. Observe Vascular giza after 45 minutes, A group of bowel from the distal to the proximal gradually dark color, bilateral ligation of blood vessels at small bowel, pulsing weak group bowel color without obvious change, small bowel end pulsing. Wendy:double vascular ligation,15 minutes after the animal intestines period without obvious change color, the color, the overall bowel ruddy methods side bowel terminal small vessel pulsations. Observe Vascular giza 30 minutes later, A group of bowel from the distal to the proximal gradually dark color, bilateral ligation of blood vessels at small bowel, pulsing weak group bowel color without obvious change, small bowel end pulsing. B and D group transplant bowel and change color, small end pulsing diminishing, short-term observation group D proof B, poor blood supply to the bowel. A, C and control groups, the results of similar short-term observation bowel not obviously abnormal blood supply. Build fistula observation:each animal live all alone at least seven days, A group of animal's group 1 days made fistula intestinal tissue color, dark red blood has been bad,4, article 7 days bowel organizations have observed, indicating that the purple black necrotic, B, C group made fistula intestinal tissue changes with fistula secretion, intestinal tissue similar color rosy, build fistula exudate is myxoid secretion, transparent color, no obvious group B bowel necrosis. Wendy:double group D animal 1,4,7 days observation made fistula intestinal tissue, purple black apparent necrosis, E, F groups made fistula intestinal tissue changes with fistula secretion, intestinal tissue similar color rosy, build fistula exudate is myxoid secretion, transparent color, no obvious group E bowel necrosis. Build fistula bowel organization with conventional dyeing clew:A, D group B E tissue, and C, F, the organization's survival were similar controls.Conclusion:Take one of vascular pedicle ileum transplant bowel ligation distal 1 secondary vascular bowel can survive, transplant bowel downward extension to 2.7±tensile length of 0.3 cm, Take two vascular pedicle transplant bowel ligation distal 1 primary vascular bowel can survive, transplant bowel downward extension to 4.0±tensile length of 0.5. At the same time, with 1 ligation of vascular pedicle transplant bowel and level with two vascular pedicle transplant bowel 1 level 1 blood vessels and vessels shall safeguard bowel 2 survive. Animal experiments from broken through blood vessels, can achieve ileum branches extend bowel to vaginal reengineering replacement therapy of distance.