中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
22期
9961-9966
,共6页
丰波%呼和%王永军%张澜%庞有明%牛克成
豐波%呼和%王永軍%張瀾%龐有明%牛剋成
봉파%호화%왕영군%장란%방유명%우극성
外科皮瓣%超声检查,多普勒,彩色%穿支%高分辨力
外科皮瓣%超聲檢查,多普勒,綵色%穿支%高分辨力
외과피판%초성검사,다보륵,채색%천지%고분변력
Surgical flaps%Ultrasonography,Doppler,color%Perforating blood vessels%High definition
目的：利用高频彩色多普勒超声技术研究股前外侧穿支皮瓣穿支分布规律、体表的定位及血流动力学，评估高频彩色多普勒超声检测的准确性，为术前供区选择双侧中的优势侧提供参考依据。方法运用高频彩超对30例健康志愿者及13例股前外侧穿支皮瓣手术患者的双侧穿支血管数目、管径、起点位置、走行位置、穿深筋膜位置、平均流速进行检测，并与术中观察到的穿支血管数据及Dopplar超声探测数据进行对比，并做统计学分析。结果30例健康人及13例患者共检测到穿支动脉192条，其中肌皮穿支型占79.3%；肌间隙皮支型18.6%，直接皮血管型2.1%。穿支管径（外径）（1.02±0.41） mm；平均血流速度左右侧差异无统计学意义（P＞0.05），男性稍高于女性（P＜0.05）。Dopplar超声与彩色多普勒超声、术中比较，差异有统计学意义（P＜0.05）。彩色多普勒超声与术中比较，差异无统计学意义（P＞0.05）。频谱显示：收缩期正向波，舒张期流速极低或没有血流，呈低速高阻单相频谱。结论高频彩色多普勒超声可以直观地观察到旋股外侧动脉、旋股外侧动脉降支及较粗大穿支的数量、管径、管壁结构、走行方向、分布区域、血流动力学性状，评价血管质量以及进行体表定位。13例手术患者中检测到的穿支结果与手术中所见的穿支数量、位置、管径基本吻合。高频彩色多普勒超声可以较精确地了解股前外侧穿支皮瓣供区血管穿支的情况，为临床选择优势侧皮瓣供区提供了较直观的依据。
目的：利用高頻綵色多普勒超聲技術研究股前外側穿支皮瓣穿支分佈規律、體錶的定位及血流動力學，評估高頻綵色多普勒超聲檢測的準確性，為術前供區選擇雙側中的優勢側提供參攷依據。方法運用高頻綵超對30例健康誌願者及13例股前外側穿支皮瓣手術患者的雙側穿支血管數目、管徑、起點位置、走行位置、穿深觔膜位置、平均流速進行檢測，併與術中觀察到的穿支血管數據及Dopplar超聲探測數據進行對比，併做統計學分析。結果30例健康人及13例患者共檢測到穿支動脈192條，其中肌皮穿支型佔79.3%；肌間隙皮支型18.6%，直接皮血管型2.1%。穿支管徑（外徑）（1.02±0.41） mm；平均血流速度左右側差異無統計學意義（P＞0.05），男性稍高于女性（P＜0.05）。Dopplar超聲與綵色多普勒超聲、術中比較，差異有統計學意義（P＜0.05）。綵色多普勒超聲與術中比較，差異無統計學意義（P＞0.05）。頻譜顯示：收縮期正嚮波，舒張期流速極低或沒有血流，呈低速高阻單相頻譜。結論高頻綵色多普勒超聲可以直觀地觀察到鏇股外側動脈、鏇股外側動脈降支及較粗大穿支的數量、管徑、管壁結構、走行方嚮、分佈區域、血流動力學性狀，評價血管質量以及進行體錶定位。13例手術患者中檢測到的穿支結果與手術中所見的穿支數量、位置、管徑基本吻閤。高頻綵色多普勒超聲可以較精確地瞭解股前外側穿支皮瓣供區血管穿支的情況，為臨床選擇優勢側皮瓣供區提供瞭較直觀的依據。
목적：이용고빈채색다보륵초성기술연구고전외측천지피판천지분포규률、체표적정위급혈류동역학，평고고빈채색다보륵초성검측적준학성，위술전공구선택쌍측중적우세측제공삼고의거。방법운용고빈채초대30례건강지원자급13례고전외측천지피판수술환자적쌍측천지혈관수목、관경、기점위치、주행위치、천심근막위치、평균류속진행검측，병여술중관찰도적천지혈관수거급Dopplar초성탐측수거진행대비，병주통계학분석。결과30례건강인급13례환자공검측도천지동맥192조，기중기피천지형점79.3%；기간극피지형18.6%，직접피혈관형2.1%。천지관경（외경）（1.02±0.41） mm；평균혈류속도좌우측차이무통계학의의（P＞0.05），남성초고우녀성（P＜0.05）。Dopplar초성여채색다보륵초성、술중비교，차이유통계학의의（P＜0.05）。채색다보륵초성여술중비교，차이무통계학의의（P＞0.05）。빈보현시：수축기정향파，서장기류속겁저혹몰유혈류，정저속고조단상빈보。결론고빈채색다보륵초성가이직관지관찰도선고외측동맥、선고외측동맥강지급교조대천지적수량、관경、관벽결구、주행방향、분포구역、혈류동역학성상，평개혈관질량이급진행체표정위。13례수술환자중검측도적천지결과여수술중소견적천지수량、위치、관경기본문합。고빈채색다보륵초성가이교정학지료해고전외측천지피판공구혈관천지적정황，위림상선택우세측피판공구제공료교직관적의거。
Objective To study the distribution pattern of the perforating blood vessels, body surface positioning and haemodynamics in dissociative anterolateral thigh flap (ALTF) by making use of high frequency color Doppler technology, which will provide the reference evidence in selecting the advantage side between the two donor sides prior to surgery. Methods To test the number, caliber, starting point, traveling course, location passing through the deep fascia, mean flow rate of two-side ALFT perforating blood vessels on 30 healthy volunteers and 13 cases of surgical patients by high frequency color Doppler, and by making the comparison of the observation of perforating blood vessels during the surgery with that detected by color Doppler, statistic analysis had been conducted. Results All together 192 perforating arteries had been detected among 30 healthy people and 13 cases of patients, and among which 79.3% were myocutaneous perforator, 18.6% were septocutaneous perforator and 2.1% were direct cutaneous perforator. Perforating caliber was (1.02±0.41)mm;There was no statistic significance between left side and right side in mean flow rate of blood(P>0.05), but there was statistic significance between males and females, with higher mean flow rate among males than females(P<0.05). There was no statistic significance between color Doppler findings and surgical observations(P>0.05). Frequency spectrum demonstration:forward wave in contraction period, extreme slow flow rate or without blood flow in diastole period with low speed and high resistance one-way spectrum. Conclusions High frequency color Doppler can directly observe lateral femoral circumflex artery, the descending branch of the lateral circumflex femoral artery, as well as the characters of bigger perforating blood vessels in terms of number, caliber, structure of blood vessel wall, extending direction, distribution area, haemodynamics, blood vessel quality evaluation and body surface positioning. The perforating results in 13 cases of patients observed during surgeries are consistent with the detection by Doppler from perspective of perforating numbers, location and caliber. High frequency color Doppler provides direct evidence for clinical selection in advantage side of skin flap by precisely obtaining the information of perforating blood vessels at the ALTP donor site.
