PDE系统在术中预测皮瓣存活的应用价值  

The Application of PDE System in Predicting the Survival of Flap

作　　者：徐晓庆[1] 苏映军[1] 郭树忠[1] 

机构地区：[1]第四军医大学西京医院整形外科,陕西西安710032

出　　处：《中国美容医学》2017年第5期27-30,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨利用PDE系统进行的吲哚菁绿(ICG)近红外荧光成像于术中预测皮瓣存活的可行性、准确性及其临床应用价值。方法:SD大鼠25只,构建大鼠背部2cm×6cm大小带蒂筋膜皮瓣,利用PDE系统进行术中ICG造影成像,对比表皮面和筋膜面的影像结果。将皮瓣等分成10个目标区域(ROI),定义灌注指数为一个ROI的光密度值比上皮瓣近端3个ROI的光密度平均值。分析灌注指数与皮瓣存活比的关系。结果:根据筋膜面ICG影像预测皮瓣存活比为0.705±0.053,灵敏度为90.7%,特异度为100%;根据表皮面ICG影像预测皮瓣存活比为0.611±0.072,其灵敏度为78.6%,特异度为100%。而实际皮瓣存活比为0.777±0.062。ROI的皮瓣存活比与其灌注指数,两者在0.01水平上显著相关(P<0.01),R为0.845,其95%置信区间为(0.434,0.965)。结论:PDE系统能够于术中预测皮瓣存活情况,灵敏度为90.7%,特异度为100%;从筋膜面进行ICG成像的结果较表皮面更为准确,灵敏度更高;当灌注指数PI>0.434时,该区域的皮瓣基本能够存活。Objective To investigate the feasibility, accuracy and clinical value of indocyanine green （ICG） near infrared fluorescence imaging in predicting the survival of flaps with PDE system. Methods Twenty-five SD rats were used. The pedicled fascia flap was implanted with 2cm＆#215;6cm in the back of the rat. The intraoperative ICG angiography was performed by PDE system, and the images of the epidermis and fascia were compared. The flap was divided into 10 regions of interest （ROI）. The perfusion index is the ratio of the optical density of an ROI to the mean value of the optical density of the three ROIs of the proximal flap. We analyzed the relationship between perfusion index and flap survival of an ROI. Results The survival ratio of the flap was （0.705±0.053） based on the ICG image of the fascia side. The sensitivity was 90.7% and the specificity was 100%. The survival ratio of the flap was （0.611±0.072） according to the ICG image of the epidermis side. The sensitivity was 78.6% and the specificity was 100%. The survival ratio of the flap was （0.777±0.062） in actually. The survival ratio and the perfusion index of an ROI were significantly correlated （P〈0.01）. R was 0.845, with a 95% confidence interval of 0.434-0.965. Conclusion PDE system could predict the survival of flap intraoperative, the sensitivity was 90.7%, and the specificity was 100%. PDE imaging from the fascia side was more accurate and more sensitive than the epidermis side. The regions of the flap which PI〉0.434 was able to survive.

关 键 词：PDE系统 吲哚菁绿 皮瓣存活比 筋膜面 表皮面 灌注指数 

分 类 号：R622[医药卫生—整形外科]