中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2013年
4期
322-326
,共5页
范新宇%徐永清%徐龙江%董凯旋%苏锡雄%许立奇%龙海%李军%朱跃良
範新宇%徐永清%徐龍江%董凱鏇%囌錫雄%許立奇%龍海%李軍%硃躍良
범신우%서영청%서룡강%동개선%소석웅%허립기%룡해%리군%주약량
超声造影%穿支皮瓣%腹壁下动脉穿支%胸背动脉穿支%旋股外侧动脉穿支%腓动脉穿支%胫后动脉穿支
超聲造影%穿支皮瓣%腹壁下動脈穿支%胸揹動脈穿支%鏇股外側動脈穿支%腓動脈穿支%脛後動脈穿支
초성조영%천지피판%복벽하동맥천지%흉배동맥천지%선고외측동맥천지%비동맥천지%경후동맥천지
Contrast-enhanced ultrasound%Perforator flap%Deep inferior epigastric artery perforator%Arteria thoraco-dorsalis artery perforator%Lateral femoral circumflex artery perforator%Peroneal artery perforator%Posterior tibial artery perforator
目的 应用高频超声及超声造影增强技术(CEUS),定位并检查穿支血管,为皮瓣手术的方案设计和操作提供准确依据 方法 2011年12月至2012年7月对我科49例拟行穿支皮瓣手术患者,在高频彩超基础上运用CEUS行术前探测:皮瓣供区做穿支血管出肌点定位和血管三维重建,测量血管管径及峰值流速；皮瓣受区探测有无血管硬化,有无炎症、脓腔及液性坏死.根据穿支血管直径和峰值流速,结合血管三维图像,首选直径粗、峰值流速快、血管走行平直的穿支血管,设计并切取皮瓣. 结果 49例患者,43例在拟切取皮瓣的49个区域共找到117支穿支,平均每个区域找到2.39个穿支,除6例12个第四腰动脉穿支皮瓣术前探测的30个穿支血管因不需要显露、术中未证实外,其余87个穿支血管均在术中得到证实,所有皮瓣均成活.6例患者根据术前探测结果,认为不适合做穿支皮瓣,改行其他手术,疗效良好.结论 高频彩超能准确定位穿支血管并了解受区情况,结合CEUS可以获得更清晰连续的二维图像和三维立体图像,是提高穿支皮瓣手术准确性和成功率的有效手段.
目的 應用高頻超聲及超聲造影增彊技術(CEUS),定位併檢查穿支血管,為皮瓣手術的方案設計和操作提供準確依據 方法 2011年12月至2012年7月對我科49例擬行穿支皮瓣手術患者,在高頻綵超基礎上運用CEUS行術前探測:皮瓣供區做穿支血管齣肌點定位和血管三維重建,測量血管管徑及峰值流速；皮瓣受區探測有無血管硬化,有無炎癥、膿腔及液性壞死.根據穿支血管直徑和峰值流速,結閤血管三維圖像,首選直徑粗、峰值流速快、血管走行平直的穿支血管,設計併切取皮瓣. 結果 49例患者,43例在擬切取皮瓣的49箇區域共找到117支穿支,平均每箇區域找到2.39箇穿支,除6例12箇第四腰動脈穿支皮瓣術前探測的30箇穿支血管因不需要顯露、術中未證實外,其餘87箇穿支血管均在術中得到證實,所有皮瓣均成活.6例患者根據術前探測結果,認為不適閤做穿支皮瓣,改行其他手術,療效良好.結論 高頻綵超能準確定位穿支血管併瞭解受區情況,結閤CEUS可以穫得更清晰連續的二維圖像和三維立體圖像,是提高穿支皮瓣手術準確性和成功率的有效手段.
목적 응용고빈초성급초성조영증강기술(CEUS),정위병검사천지혈관,위피판수술적방안설계화조작제공준학의거 방법 2011년12월지2012년7월대아과49례의행천지피판수술환자,재고빈채초기출상운용CEUS행술전탐측:피판공구주천지혈관출기점정위화혈관삼유중건,측량혈관관경급봉치류속；피판수구탐측유무혈관경화,유무염증、농강급액성배사.근거천지혈관직경화봉치류속,결합혈관삼유도상,수선직경조、봉치류속쾌、혈관주행평직적천지혈관,설계병절취피판. 결과 49례환자,43례재의절취피판적49개구역공조도117지천지,평균매개구역조도2.39개천지,제6례12개제사요동맥천지피판술전탐측적30개천지혈관인불수요현로、술중미증실외,기여87개천지혈관균재술중득도증실,소유피판균성활.6례환자근거술전탐측결과,인위불괄합주천지피판,개행기타수술,료효량호.결론 고빈채초능준학정위천지혈관병료해수구정황,결합CEUS가이획득경청석련속적이유도상화삼유입체도상,시제고천지피판수술준학성화성공솔적유효수단.
Objective To study the distribution and flowing dynamics of perforator vessel of perforator flap detected by high frequency color ultrasound and contrast-enhaned ultrasound (CEUS) in order to provide reasonable evidence for the design of location and protocol of skin flap.Methods From December 2011 to July 2012,forty-nine patients with soft tissue defects were studied by CEUS and 3D ultrasound.In addition to the position where the blood vessel perforates from muscle into adipose layer,the research emphasized to display the relationship of perforator and its source vessel,detect the number of perforator vessel vascular initial diameter,distribution,and flowing dynamics in the donor site.The straighter and bigger perforators were the first choices.The infection and hardening of the arteries were detected in the accepting-site.Results Among them,forty-three subjucts were observed more clearly with CEUS than conventional ultrasound,totally 117 perforators were found in 49 donr sites.Perforators which were detected by ultrasound were confirmed in the surgery except 30 perforators of the fourth lumbar arteries.The transferred flaps survived completely.Conclusion Perforators can be displayed more clearly and located more accurately by CEUS,which plays a very important role in perforator flap.Three dimentional ultrasound can display excellent images with the information of perforators for clinical surgery.
