应用高频彩超进行股前外侧穿支血管的术前定位与选择  

Application of high-frequency color ultrasound in preoperative identification and selection of perforator for anterolateral thigh flap grafts

作　　者：黄健[1] 沈毅[1] 陆林国[2] 黄冠兰[2] 周辉红[2] 陈倩倩[2] 李军[1] 孙坚[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科,上海市口腔医学重点实验室,上海200011 [2]上海交通大学医学院附属第九人民医院超声科,上海200011

出　　处：《中国口腔颌面外科杂志》2015年第1期42-47,共6页China Journal of Oral and Maxillofacial Surgery

基　　金：上海市科学技术委员会资助项目(08DZ2271100);上海交通大学医学院院基金(13XJ10049)~~

摘　　要：目的 :探讨术前根据高频彩色多普勒超声定位结果选择合适穿支血管的依据,用于指导皮瓣制备。方法 :2013年3月—12月,对52例共102侧拟行股前外侧穿支皮瓣修复口腔颌面-头颈肿瘤术后缺损的患者,术前采用高频彩色多普勒超声探测双下肢股前外侧穿支血管,了解穿支数目、来源、走行、位置、管径及血流动力学等信息,选择血供良好的区域作为皮瓣供区,指导皮瓣设计与制备,并与术中实时情况对比,探讨高频彩色多普勒超声选择合适股前外侧穿支血管的依据。采用SAS 9.2软件包比较术前和术中检测结果有无显著差异。结果:52例患者术前共定位出208支穿支,最终27例患者采用股前外侧穿支皮瓣修复颌面部组织缺损。术前超声检测穿支血管的各项指标与术中实时情况对比,两者间无显著差异(P>0.05)。结论:术前应用高频彩色多普勒超声能够较精确地定位和选择股前外侧皮瓣的穿支血管。其选择依据为:1穿支血管管径大小为首要考虑指标;2优先考虑行程较短、易解剖的肌间隔或半肌间隔穿支;3选择流速快、阻力指数小的穿支;4穿支血管蒂长度满足修复重建的需求。PURPOSE： To explore the accuracy of selecting appropriate perforator vessels according to the results of preoperative high-frequency color Doppler ultrasound and guide anterolateral thing（ALT） flap harvest. METHODS：From March 2013 to December 2013, fifty-two patients underwent preoperative ultrasound before ALT harvest for head and neck cancer reconstruction. Ultrasonography was used to predict the number, origin, course, location, diameter and hemodynamics of perforators in order to choose the better donor site for flap harvest. The preoperatively mapped perforators were compared with the actual intraoperative findings. Chi-square test was carried out for comparison between preoperative and intraoperative results using SAS 9.2 software package. RESULTS： A total of 208 perforators were found by preoperative ultrasound in 52 patients. Finally 27 patients underwent ALT reconstruction for head and neck defects.There were no significant difference between preoperative and real situation of intraoperative perforator indicators（ P〉0.05）.CONCLUSIONS： Preoperative mapping of perforators by ultrasound proved valuable in ALT flap design and harvest. The basis for ALT graft is as follows： 1 perforator diameter is the first factor to be considered; 2priority to the septum or half septum perforator which is easily dissected;3 select the perforator with high flow velocity and low resistance index;4 the pedicle length of perforator meets the needs of reconstruction.

关 键 词：超声 股前外侧穿支皮瓣 术前计划 

分 类 号：R739.91[医药卫生—肿瘤]