CAJ | 학술논문

目的:研究彩色多普勒超声(color duplex sonography,CDS)与CT血管造影(computer tomography angiography,CTA)两种常用术前穿支血管定位技术在旋髂浅动脉穿支皮瓣辅助设计及其准确度、敏感度对比的应用,为游离旋髂浅动脉穿支皮瓣修复口腔颌面部肿瘤术后缺损提供理论支持.方法:选取罹患口腔颌面部恶性肿瘤患者需行手术及同期软组织修复29例,术前应用CDS、CTA技术对患者双侧腹股沟区旋髂浅动脉穿支进行检测,并记录血管相关检查结果,对检查数据进行统计分析.制备18例游离旋髂浅动脉穿支皮瓣,以术中解剖证实结果为金标准,设计诊断试验,探讨CDS、CTA两种技术用于诊断旋髂浅动脉穿支是否存在及管径大小的准确性.结果:18例患者行皮瓣制备,其中1例术中未探及血管、17例术中行旋髂浅动脉管径测量,平均管径为(0.69±0.20)mm.在诊断血管有无的试验中,CDS敏感度为75.0%、特异度为82.4%,ROC曲线下面积为0.79;CTA敏感度为75.0%、特异度为94.2%,ROC曲线下面积为0.85.术前测量的CDS、CTA平均管径分别为(0.84±0.14)、(1.01±0.19)mm,将CDS、CTA技术术前测量的管径大小分别与术中对比,穿支动脉管径(D)分别与CDS、CTA测量的管径值两两间比较,差异具有统计学意义(P<0.05).结论:CDS、CTA是用于术前检测穿支血管相对可靠的技术.利用CDS、CTA术前为旋髂浅动脉穿支皮瓣定位穿支血管,可为术者提供与该穿支血管的走行、毗邻以及穿出点的精确信息,并一定程度反映血管管径大小.
목적:연구채색다보륵초성(color duplex sonography,CDS)여CT혈관조영(computer tomography angiography,CTA)량충상용술전천지혈관정위기술재선가천동맥천지피판보조설계급기준학도、민감도대비적응용,위유리선가천동맥천지피판수복구강합면부종류술후결손제공이론지지.방법:선취리환구강합면부악성종류환자수행수술급동기연조직수복29례,술전응용CDS、CTA기술대환자쌍측복고구구선가천동맥천지진행검측,병기록혈관상관검사결과,대검사수거진행통계분석.제비18례유리선가천동맥천지피판,이술중해부증실결과위금표준,설계진단시험,탐토CDS、CTA량충기술용우진단선가천동맥천지시부존재급관경대소적준학성.결과:18례환자행피판제비,기중1례술중미탐급혈관、17례술중행선가천동맥관경측량,평균관경위(0.69±0.20)mm.재진단혈관유무적시험중,CDS민감도위75.0%、특이도위82.4%,ROC곡선하면적위0.79;CTA민감도위75.0%、특이도위94.2%,ROC곡선하면적위0.85.술전측량적CDS、CTA평균관경분별위(0.84±0.14)、(1.01±0.19)mm,장CDS、CTA기술술전측량적관경대소분별여술중대비,천지동맥관경(D)분별여CDS、CTA측량적관경치량량간비교,차이구유통계학의의(P<0.05).결론:CDS、CTA시용우술전검측천지혈관상대가고적기술.이용CDS、CTA술전위선가천동맥천지피판정위천지혈관,가위술자제공여해천지혈관적주행、비린이급천출점적정학신식,병일정정도반영혈관관경대소.
Objective:To evaluate the accuracy of the application of color Doppler sonography (CDS) and computer tomography angiography (CTA) in preoperative perforator identification and flap design and provide theoretical support for the restoration of oral maxillofacial defect with free superficial circumflex iliac artery perforator flap (SCIAPF). Methods: (1) Preoperative CDS and CTA techniques were performed to map the SCIA perforators of 29 adult patients diagnosed with malignant tumor in the oral maxillofacial head and neck regions. These patients were scheduled for concurrent reconstruction surgery. (2) A diagnostic test was designed to com-pare the CDS and CTA techniques. Results:(1) A total of 18 patients underwent flap preparation. SCIA was not found in one of the pa-tients during surgery, but was observed intra-operatively in the other 17 patients. The average SCIA diameter was 0.69 ± 0.20 mm. (2) The diagnostic test showed a CDS sensitivity of 75.0%, a CDS specificity of 82.4%, and an area under the ROC curve of 0.79. The CTA sensitivity was 75.0%, the specificity was 94.2%, and the area under the ROC curve was 0.85. The diameters measured by CDS and CTA were compared with the diameter measured intra-operatively. Significant differences were observed among the three diame-ters (P<0.05). The average diameter measured by CDS was 0.84 ± 0.14 mm. The average diameter measured by CTA was 1.01 ± 0.19 mm. Conclusion:CDS and CTA are relatively reliable technologies for preoperative detection of perforator vessel. The use of CDS and CTA technology mapping for SCIAPF can provide accurate information about the perforator, including the position of the perforator and the relationship between the peripheral tissues and the caliber of the vessel.