CT血管造影预估近端蒂股前外侧皮瓣血管蒂长度的临床应用研究  

Clinical application of computed tomographic angiography in predicting the vascular pedicle length of the proximally-based anterolateral thigh flap

作　　者：王丹莹 刘元波 陈威威 臧梦青 朱珊 陈博 李杉珊 WANG Danying;LIU Yuanbo;CHEN Weiwei;ZANG Mengqing;ZHU Shan;CHEN Bo;LI Shanshan(Scar Comprehensive Treatment Center,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,100144,P.R.China;Radiology Department,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,100144,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院瘢痕综合治疗中心,北京100144 [2]中国医学科学院北京协和医学院整形外科医院放射科,北京100144

出　　处：《中国修复重建外科杂志》2022年第3期322-328,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用CT血管造影(CT angiography,CTA)行穿支血管定位及血管蒂长度预估,辅助近端蒂股前外侧(proximally-based anterolateral thigh,pALT)皮瓣设计,修复恶性肿瘤切除术后缺损的可行性。方法回顾分析2015年6月—2020年12月应用pALT皮瓣修复恶性肿瘤切除后遗留创面且符合选择标准的12例患者临床资料。男5例,女7例;年龄16~80岁,平均54.4岁。肿瘤切除后软组织缺损范围为15 cm×5 cm~30 cm×12 cm;缺损部位:下腹部4例、腹股沟3例、大腿2例、臀部3例。术前采用CTA以最大密度投影获得旋股外侧动脉降支及其穿支的定位信息,预估pALT皮瓣血管蒂长度。术中切取筋膜皮瓣(5例)或肌皮瓣(7例)修复缺损,皮瓣切取范围为20 cm×7 cm~30 cm×12 cm;大腿供区直接拉拢缝合(11例)或植皮修复(1例)。应用Bland-Altman分析法检测CTA预估的pALT皮瓣血管蒂长度与术中实际获得的pALT皮瓣血管蒂长度之间的一致性。结果术后1例出现皮瓣远端血运障碍,清创后应用植皮修复;余11例皮瓣全部成活。供受区切口均Ⅰ期愈合。12例均获随访,随访时间1~12个月,平均4.3个月。1例患者术后6个月因盆腔肿瘤复发死亡,余患者未见肿瘤复发。术前CTA预估pALT皮瓣血管蒂长度为9.3~24.7 cm,平均14.7 cm;术中实际获得的pALT皮瓣血管蒂长度为9.5~25.0 cm,平均14.8 cm。Bland-Altman分析示,术前CTA预估pALT皮瓣血管蒂长度与术中实际获得的pALT皮瓣血管蒂长度无显著差异,平均差值为0.1(95%一致限:-0.89,0.74),说明二者具有较好的一致性。结论 CTA可准确探查pALT皮瓣穿支血管位置,预估皮瓣血管蒂长度,从而减少术中穿支探查、血管蒂剥离时间,降低并发症发生率,提高手术安全性。Objective To explore the reliability and effectiveness of prediction of the pedicle length of the proximally-based anterolateral thigh(pALT) flap which was used to repair the defects following the resection of various malignant tumors using computed tomographic angiography(CTA). Methods The clinical data of 12 patients who met the selection criteria by using pALT flap to repair wounds left after malignant tumor resection between June 2015 and December 2020 were retrospectively analyzed. There were 5 males and 7 females;the age ranged from 16 to 80 years,with an average age of 54.4 years. After tumor resection, the soft tissue defect ranged from 15 cm×5 cm to 30 cm×12 cm;defect sites included 4 cases of lower abdomen, 3 cases of groin, 2 cases of thigh, and 3 cases of buttocks. Preoperative CTA was used to obtain the location information of the descending branch of the lateral femoral circumflex artery and its perforators by maximum density projection, and the length of the pedicle of pALT flap was estimated.Fasciocutaneous flap(5 cases) or myocutaneous flap(7 cases) were cut during operation to repair the defect, and the size of flap ranged from 20 cm×7 cm to 30 cm×12 cm. The donor site of thigh was directly sutured(11 cases) or repaired with skin graft(1 case). Bland-Altman analysis was used to detect the consistency between the pALT flap vascular pedicle length estimated by CTA and the pALT flap vascular pedicle length actually obtained during operation. Results One case had distal blood supply disturbance of the flap and was repaired with skin graft after debridement;the remaining 11 flaps survived. All donor and recipient incisions healed by first intention. All 12 cases were followed up 1-12 months, with an average of 4.3 months. One patient died of pelvic tumor recurrence at 6 months after operation,and no tumor recurrence was found in the other patients. Preoperative CTA estimated that the length of pALT flap vascular pedicle was 9.3-24.7 cm, with an average of 14.7 cm;the actual length of pALT flap va

关 键 词：近端蒂股前外侧皮瓣 CT血管造影 血管蒂长度 缺损修复 

分 类 号：R658.3[医药卫生—外科学]