CT血管成像及三维重建辅助设计与彩色多普勒超声在口腔癌术后缺损股前外侧皮瓣修复重建中的应用比较  

Comparative study on anterolateral thigh flap by three-dimensional CT angiography assisted design and color Doppler ultrasound in reconstruction after oral cancer

作　　者：吴双江 王雷 刘一秀 贾娟 夏德林 Wu Shuangjiang;Wang Lei;Liu Yixiu;Jia Juan;Xia Delin(Department of Oral and Maxillofacial Surgery,the Affiliated Stomatological Hospital of Southwest Medical University,Luzhou 646000,China;Department of Oral and Maxillofacial Surgery,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Luzhou Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,Luzhou 646000,China;Key Laboratory for Biorheological Science and Technology of Ministry of Education(Chongqing University),Chongqing University Cancer Hospital&Chongqing Cancer Institute&Chongqing Cancer Hospital,Chongqing 400044,China;Medical Cosmetic Center,the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属口腔医院口腔颌面外科,泸州646000 [2]西南医科大学附属医院口腔颌面外科,泸州646000 [3]口腔颌面修复重建和再生泸州市重点实验室,泸州646000 [4]重庆大学附属肿瘤医院,重庆市肿瘤研究所,重庆市肿瘤医院,教育部生物流变科学与技术重点实验室(重庆大学),重庆400044 [5]西南医科大学附属中医医院医学美容中心,泸州646000

出　　处：《中华整形外科杂志》2022年第10期1102-1110,共9页Chinese Journal of Plastic Surgery

基　　金：西南医科大学应用基础青年项目(2018-ZRQN-071)。

摘　　要：目的比较计算机体层血管成像(CTA)及血管三维重建定位旋股外侧动脉及其穿支血管辅助设计股前外侧皮瓣与彩色多普勒超声(CDU)定位制备股前外侧皮瓣在口腔癌术后软组织缺损修复重建中的应用效果。方法回顾性分析2013年1月至2020年1月西南医科大学附属口腔医院口腔颌面外科口腔癌术后软组织缺损应用股前外侧皮瓣修复患者的临床资料。根据测量穿支血管的影像学方法不同, 将患者分为2组, A组术前采用CTA及血管三维重建定位旋股外侧动脉及其穿支血管辅助设计股前外侧皮瓣, B组术前采用CDU定位制备股前外侧皮瓣。比较2组患者一般资料、手术时间、皮瓣存活率、术后并发症发生率、血管成像质量、术前与术中穿支血管皮肤浅出点位置差值、穿支动脉血管内径等指标。采用SPSS 20.0软件进行统计分析。计量资料采用±s表示, 2组间差异性比较采用独立样本t检验, 组内差异性比较采用配对样本t检验;计数资料采用例数(%)表示, 组间比较采用χ~2检验;双人不同时间2次血管成像质量评分采用可靠性分析, 取Cronbach’s α值;体质量指数(BMI)与皮瓣存活情况的相关性分析采用Pearson相关性检验;基础疾病、合并用药、不良烟酒嗜好及术后并发症与皮瓣存活情况的相关性分析采用Spearman相关性检验。P<0.05表示差异有统计学意义。结果共收集50例口腔癌患者, 每组各25例。2组患者性别分布、年龄、TNM分期、BMI、合并基础疾病、合并用药、不良烟酒嗜好、肿瘤发生部位等一般资料比较, 差异无统计学意义(P均>0.05)。A组手术时间显著短于B组, 差异有统计学意义[(67.64±5.94) min vs.(70.88±4.88) min, P<0.05];A组皮瓣全部成活, B组皮瓣坏死1例, 2组皮瓣存活率差异无统计学意义(100% vs. 96%, P>0.05);A组1例、B组2例出现供区创面积液等并发症, 差异无统计学意义(P>0.05)。2组影像图像质�Objective To compare the effect of three-dimensional CT angiography(CTA)and color Doppler ultrasound(CDU)in reconstruction of soft tissue defects after oral cancer surgery with anterolateral thigh flap(ALTF).Methods Patients who underwent reconstruction of postoperative defects with ALTF in Department of Oral and Maxillofacial Surgery,the Affiliated Stomatological Hospital of Southwest Medical University from January 2013 to January 2020 were retrospectively reviewed.According to the imaging method used for examining perforating artery,all patients were divided into two groups.In group A,CTA and three-dimensional vascular reconstruction were used to locate the lateral femoral circumflex artery and its perforating vessels,and the individualized ALTF was designed.In group B,the lateral circumflex femoral artery and its perforating vessels were located by CDU.The clinical features,operation time,flap survival rate,postoperative complication rate,image quality of angiography,difference of superficial skin points of perforating vessels before and during operation,and diameter of perforators were compared between the two groups.The measurement data were expressed by Mean±SD,and the differences between the two groups were compared by independent sample t-test;paired sample t-test was used to compare the intra-group differences;patients’clinical features and other enumeration data were expressed in the number of cases(%),and analyzed by chi-square test;reliability analysis was adopted for the image quality score of two doctors at different times,taking Cronbach’sαvalue;correlations between body mass index(BMI)and flap survival rate were tested by Pearson correlation,whereas the correlation between flap survival rate and underlying diseases,drug combination,bad smoking and drinking habits,and surgical complications were tested by Spearman correlation,which were all performed using SPSS version 20.0 at significance level P<0.05.Results A total of 50 patients with oral cancer were collected,25 patients in each group.T

关 键 词：口腔肿瘤 软组织缺损 股前外侧皮瓣 修复重建 CT血管成像 三维重建 彩色多普勒超声 

分 类 号：R739.8[医药卫生—肿瘤]