Microsurgery Department, Jesús Usón Minimally Invasive Surgery Centre. Ctra. N-571, KM 41,8. 10071 Cáceres, Spain.
J Pediatr Surg. 2012 Jul;47(7):1390-8. doi: 10.1016/j.jpedsurg.2011.12.015.
BACKGROUND/PURPOSE: Our aim was to perform a macroscopic and imaging (ultrasonographic and angiographic) evaluation of vascular closure stapler (VCS) metallic clips for renal transplantation in growing piglets to assess their role for transplantation surgery in young children. If these techniques are to be useful, it is necessary to prove that their use avoids one of the main pitfalls of conventional sutures in this setting, namely lack of growth in the suture line.
Twenty-four piglets were used for this study. Animals were subjected to a heterotopic renal autotransplantation when they were 45 days old. The right kidney was moved from its normal location to the cranial area of the iliac fossa. The end-to-side anastomoses between the renal artery and vein and the aorta and vena cava, respectively, were performed using VCS metallic clips in 6 animals. Continuous polypropylene suturing was used in another 6 piglets, and continuous polyglycolic acid suture was used in 6 additional piglets. A control group of 6 animals without renal autotransplantation was also included in the study. All animals were allowed to grow for 6 months, during which time serial angiographic and ultrasonographic studies were carried out to assess the existence of vascular flow disturbances or stenosis. Similarly, angiographic measurements were obtained to document growth at the anastomotic site. Longitudinal growth was evaluated postmortem after the 6-month growing period.
Angiography showed significant (P < .001) transverse growth in both arteries and veins belonging to the VCS clips, running absorbable suture, or control groups. No significant difference was observed among the 3 groups. Vascular growth in the running nonabsorbable suture (polypropylene) group, however, was significantly less than in the other 3 groups and did not significantly differ from baseline. Baseline luminal diameters at the anastomotic site as measured by angiography in the VCS group were 3.64 ± 0.40 mm in the artery and 5.30 ± 1.43 mm in the vein. After growth, these values increased to 6.87 ± 0.90 mm and 11.27 ± 2.53 mm, respectively. Significant longitudinal growth was evidenced macroscopically after 6 months in both aorta and vena cava in all groups. On the other hand, significant longitudinal growth in the renal artery and vein were only observed in the control, VCS, and absorbable suture groups.
In this experimental setting, satisfactory macroscopic and angiographic vascular growth results were obtained using the VCS clips, suggesting that this suture could be the technique of choice in pediatric transplantation surgery.
背景/目的：我们的目的是对血管闭合吻合器（VCS）金属夹在生长仔猪肾移植中的宏观和影像学（超声和血管造影）表现进行评估，以评估其在小儿移植手术中的作用。如果这些技术要有用，就必须证明它们的使用避免了传统缝线在这种情况下的主要缺陷之一，即缝线处缺乏生长。
本研究共使用 24 头仔猪。当仔猪 45 天时，将其进行异位肾自体移植。将右肾从正常位置移至髂窝颅侧。用 VCS 金属夹对 6 只动物的肾动脉和静脉与主动脉和腔静脉分别进行端侧吻合，另 6 只动物用连续聚丙烯缝线缝合，6 只动物用连续聚乙二醇酸缝线缝合。研究中还包括一组 6 只未进行肾自体移植的对照动物。所有动物均允许生长 6 个月，在此期间进行连续血管造影和超声检查以评估是否存在血管血流紊乱或狭窄。同样，也获得了血管造影测量值以记录吻合部位的生长情况。生长 6 个月后，在死后进行纵向生长评估。
血管造影显示 VCS 夹、可吸收缝线或对照组的动脉和静脉均有显著（P<0.001）的横向生长。3 组间无显著差异。然而，连续不可吸收缝线（聚丙烯）组的血管生长明显小于其他 3 组，与基线相比无显著差异。VCS 组血管造影测量的吻合部位初始管腔直径在动脉为 3.64±0.40mm，静脉为 5.30±1.43mm。生长后，这些值分别增加到 6.87±0.90mm 和 11.27±2.53mm。所有组的腹主动脉和腔静脉在 6 个月后均有明显的宏观纵向生长。另一方面，仅在对照组、VCS 组和可吸收缝线组的肾动脉和静脉观察到明显的纵向生长。
在这种实验环境下，VCS 夹获得了令人满意的宏观和血管造影血管生长结果，表明这种缝线可能是小儿移植手术的首选技术。
