CTA与手持多普勒彩超在游离股前外侧皮瓣穿支定位中的价值及研究  

The value study of CTA and handheld Doppler ultrasound in localization of free anterolateral thigh perforator flap

作　　者：张宏[1] 邵蓉 王军[1] 范向达[1] 王娟[1] 张建伟[1] 宋一丁[1] ZHANG Hong;SHAO Rong;WANG Jun(Gansu Cancer Hospital,Lanzhou 730050,China)

机构地区：[1]甘肃省肿瘤医院,730050

出　　处：《中国现代药物应用》2025年第6期51-54,共4页Chinese Journal of Modern Drug Application

基　　金：甘肃省卫生行业科研计划项目(项目编号:GSWSKY2022-21),项目名称:游离股前外侧穿支皮瓣在头颈颌面部软组织缺损修复中的临床应用及研究;甘肃省科技计划项目:甘肃省头颈肿瘤临床医学研究中心(项目编号:21JR7RA678);国家临床重点专科建设项目资金支持(项目编号:甘财社(2021)80号);甘肃省头颈肿瘤临床医学研究中心(项目编号:21JR7RA678)。

摘　　要：目的探讨CT血管造影(CTA)与手持多普勒彩超在游离股前外侧穿支皮瓣修复头颈颌面部缺损的临床价值。方法50例行游离股前外侧穿支皮瓣修复的头颈颌面部恶性肿瘤切除术后缺损患者,根据术前定位方法不同分为A组和B组,每组25例。A组术前运用CTA进行穿支血管定位,B组术前运用手持多普勒彩超进行穿支血管定位,根据定位穿支点对患者皮瓣进行术前设计及指导。比较两组患者的穿支血管吻合率、血管危象发生情况及手术时间。结果A组患者有24例穿支完全吻合,吻合率为96%(24/25),且皮瓣穿支定位准确率高,术后皮瓣全部存活,可明显缩短手术所用的时间。B组患者有22例探测到穿支,其中有3例患者术前探测到的穿支位置与术中切开后发现的穿支位置不一致,1例是来自股直肌表面发出的穿支,1例发现穿支来源于横支,并非降支,切取横支穿支皮瓣,1例术中发现穿支血管较细,穿支搏动无力,向上仔细寻找发现穿支来源于升支,并非降支;3例患者未探测到穿支,吻合率为76%(19/25)。A组穿支血管吻合率明显高于B组,差异有统计学意义(χ^(2)=4.153,P<0.05)。术后,A组未发生血管危象,B组有1例发生动脉危象,1例发生静脉危象,经急诊手术抢救后,2例皮瓣均成活,其余皮瓣未出现坏死。A组手术时间(100±20)min短于B组的(150±15)min,差异有统计学意义(P<0.05)。结论术前应用CTA检查可精准定位游离股前外侧皮瓣穿支,可提高穿支定位的准确率,为术前设计和术中切取皮瓣提供指导,明显缩短取瓣时间,减少出血量,提高皮瓣移植成功率,值得临床大力推广。Objective To explore the clinical value of CT angiography(CTA)and handheld Doppler ultrasound in the repair of head,neck and maxillofacial defects with free anterolateral thigh perforator flap.Methods 50 patients with head,neck,and maxillofacial defects after malignant tumor resection repaired by free anterolateral thigh perforator flap were divided into Group A and Group B based on different preoperative localization methods,with 25 cases in each group.CT angiography was used to locate perforating vessels in Group A before surgery,while handheld Doppler ultrasound was used to locate perforating vessels in Group B before surgery.In group A,CTA was used to localize the perforating vessels before surgery,and in group B,handheld Doppler ultrasound was used to localize the perforating vessels,and the flaps were designed and guided according to the localized perforation points.The coincidence rate of the perforating vessels,the occurrence of vascular crisis and the operation time were compared between the two groups.Results 24 patients in Group A had complete anastomosis of perforating branches,with a high anastomosis rate of 96%(24/25).The accuracy of skin flap perforating branch positioning was also high,and all flaps survived after surgery,which significantly shortened the time required for surgery.22 patients in Group B had perforating branches detected before surgery.Among them,3 patients had perforating branches detected before surgery that were not consistent with that after incision.1 patient had perforating branches originating from the surface of the rectus femoris muscle,1 patient had perforating branches originating from the transverse branch,not the descending branch.A transverse perforating branch flap was taken, and 1 patient had perforating branches with thin blood vessels and weak pulsation during surgery. Upon closer examination, it was found that the perforating branch originated from the ascending branch, not the descending branch;no perforating branches were found in 3 patients;the coincidence rat

关 键 词：CT血管造影 手持多普勒彩超 股前外侧穿支皮瓣 修复重建 头颈颌面部缺损修复 

分 类 号：R739.8[医药卫生—肿瘤]