CAJ | 학술논문

目的探讨微泡增强多普勒超声技术(microbubble-enhanced ultrasound,MEUS)在锁骨上动脉穿支皮瓣设计中的应用价值.方法 2009年5月至2013年10月,术前对20例26个皮瓣先采用常规彩色多普勒超声进行血管探查,在此基础上再行MEUS检测定位锁骨上动脉穿支血管,判断并归类锁骨上动脉穿支类型,选取管径粗、流速快、蒂部长、旋转点近的穿支血管设计皮瓣.术后对有无造影剂相关并发症及皮瓣存活情况进行随访.结果在常规彩超下探测出来自锁骨上动脉的穿支共37条,穿支管径0.5 ～0.8 mm,平均(0.6±0.1) mm;超声造影增强后,穿支血管的血流信号明显提高,探查到48条血管(P＜0.05);同一血管在MEUS下的平均管径为(0.7±0.3) mm,常规彩超下为(0.6±0.1) mm,前者明显高于后者(P＜0.05).MEUS和三维重建结果显示,锁骨上动脉前胸支在65.4％(17/26)的皮瓣中管径大,血流稳定,可以作为穿支皮瓣的优势血管.26个皮瓣术前定位的穿支在术中均获得证实,并有25个采用了术前定位的血管作为血管蒂,1个由于术中发现穿支细、蒂部短而改用扩张的胸廓内动脉穿支皮瓣游离移植.仅有1例发生造影剂相关不良反应,表现为恶心、胃纳差等胃肠道反应,未予治疗,1d后自行好转.术后随访3～16个月,平均8个月,皮瓣色泽、质地良好.结论锁骨上动脉作为进入皮瓣的终末支血管,存在不同的穿支类型.MEUS作为一项准确、可靠的术前探测手段,可应用于锁骨上动脉穿支的术前定位,以选择优势血管而设计最佳皮瓣,提高手术成功率.
목적 탐토미포증강다보륵초성기술(microbubble-enhanced ultrasound,MEUS)재쇄골상동맥천지피판설계중적응용개치.방법 2009년5월지2013년10월,술전대20례26개피판선채용상규채색다보륵초성진행혈관탐사,재차기출상재행MEUS검측정위쇄골상동맥천지혈관,판단병귀류쇄골상동맥천지류형,선취관경조、류속쾌、체부장、선전점근적천지혈관설계피판.술후대유무조영제상관병발증급피판존활정황진행수방.결과 재상규채초하탐측출래자쇄골상동맥적천지공37조,천지관경0.5 ～0.8 mm,평균(0.6±0.1) mm;초성조영증강후,천지혈관적혈류신호명현제고,탐사도48조혈관(P＜0.05);동일혈관재MEUS하적평균관경위(0.7±0.3) mm,상규채초하위(0.6±0.1) mm,전자명현고우후자(P＜0.05).MEUS화삼유중건결과현시,쇄골상동맥전흉지재65.4％(17/26)적피판중관경대,혈류은정,가이작위천지피판적우세혈관.26개피판술전정위적천지재술중균획득증실,병유25개채용료술전정위적혈관작위혈관체,1개유우술중발현천지세、체부단이개용확장적흉곽내동맥천지피판유리이식.부유1례발생조영제상관불량반응,표현위악심、위납차등위장도반응,미여치료,1d후자행호전.술후수방3～16개월,평균8개월,피판색택、질지량호.결론 쇄골상동맥작위진입피판적종말지혈관,존재불동적천지류형.MEUS작위일항준학、가고적술전탐측수단,가응용우쇄골상동맥천지적술전정위,이선택우세혈관이설계최가피판,제고수술성공솔.
Objective To investigate the effectiveness of microbubble-enhanced ultrasound (MEUS) for detecting perforators preoperatively in supraclavicular flap surgery.Methods From May 2009 to October 2013,there were 20 patients (26 flaps were involved) who planned to undergo supraclavicular artery based flap surgeries to recover the large-area defects in head and neck.The MEUS together with regular color Doppler ultrasound (CDUS) were conducted preoperatively to determine the anatomical features of perforators branching from supraclavicular arteries (SCA).The perforator with wider caliber,faster flow speed,longer pedicles and closer pivot point was selected and the flap was designed according to the observed results.Results There were 37 perforators of SCA detected by CDUS,whose calibers were ranging from 0.5 to 0.8 mm[Mean:(0.6 ± 0.1) mm].There were 48 perforators of SCA detected by MEUS.Compared to CDUS,the caliber obtained from MEUS for same vessel is significantly increased [(0.7 ±0.3) mm vs (0.6 ±0.1) mm,P ＜0.05].According to the results of MEUS and three-dimensional reconstructive techniques,in at least 65.4％ (17/26) of the flaps,thoracic branch of SCA (TBSA) has large caliber and good flow velocity which can be regarded as the predominant vessel and used as the pedicle of flap.The results of the operations confirmed the existences of all the marked vessels.25 flaps were obtained according to the preoperative plans and one case used perforators of internal mammary artery as free flaps since the perforator of SCA was found improper.The contrast-related complication occurred in one patient which was manifested by gastrointestinal adverse effect like nausea and anorexia.The patient recovered 1 day later without treatment.All the patients have been followed up for 3 to 16 months (Mean:8 months) with well-survived flaps.Conclusions The perforators of SCA demonstrated significant variations and preoperative mapping was vital for the success of surgery.MEUS is a valuable imaging modality for the preoperative assessment of the vascular supply for supraclavicular artery based flap.