CT血管造影在腓肠内侧动脉穿支皮瓣血管定位中的应用

中国口腔颌面外科杂志 ›› 2015, Vol. 13 ›› Issue (3): 220-225.

CT血管造影在腓肠内侧动脉穿支皮瓣血管定位中的应用

方早, 金淑芳, 田卓炜, 张陈平, 何悦

上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科,上海市口腔医学重点实验室,上海 200011

收稿日期:2014-06-05 修回日期:2014-08-05 出版日期:2015-05-20 发布日期:2015-06-18
通讯作者: 何悦,Tel:021-23271699-5656,E-mail:william5218@126.com
作者简介:方早（1989-）,女,硕士,住院医师,E-mail:fangzao36@sina.cn
基金资助:
国家自然科学基金（81271112）; 上海市人才发展计划资助项目(201312); 上海交通大学晨星计划A类（201312）

A preliminary study on application of CT angiography in accurate mapping of the free medial sural artery perforator

FANG Zao, JIN Shu-fang, TIAN Zhuo-wei, ZHANG Chen-ping, HE Yue

Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology. Shanghai 200011, China

Received:2014-06-05 Revised:2014-08-05 Online:2015-05-20 Published:2015-06-18
Supported by:
Supported by National Natural Science Foundation of China (81271112), Development Foundation of Shanghai Municipal Human Resources and Social Security Bureau (201312) and SMC Rising Star-A Scholar of Shanghai Jiao Tong University(201312)

摘要/Abstract

摘要： 目的探讨运用CT血管造影（CTA）技术定位腓肠内侧动脉穿支的精确性,基于CTA定位下了解腓肠内侧动脉穿支皮瓣的解剖学特征。方法选取9例舌癌患者,术前利用CTA技术对腓肠内侧动脉穿支进行定位,术中测量腓肠内侧动脉穿支皮瓣的相关解剖数据,测量穿支数量、皮肤穿出点位置、血管蒂长度及皮瓣厚度,运用SPSS 20.0软件包进行配对t检验,与术前CTA测量结果进行比较。结果腓肠内侧动脉穿支皮瓣血管蒂长,管径与颈部血管匹配,对供区损伤小,CTA定位的血管蒂长度、皮瓣厚度以及血管穿支到坐标原点的距离与术中测量数据进行对比,均无显著差异;术前CTA定位测量准确。结论术前运用CTA可精确定位穿支位置,利于皮瓣制备,减少手术风险和并发症。

关键词: 腓肠内侧动脉穿支皮瓣, 应用解剖, CT血管造影, 显微外科

Abstract: PURPOSE: To evaluate the application of CT angiography (CTA) in mapping the medial sural artery perforating branches, and explore the anatomy of the flap. METHODS: Preoperative CTA was performed in mapping the medial sural artery perforating branches in 9 Chinese adult patients with squamous cell carcinoma of the tongue. The perforator flap for tongue reconstruction based on preoperative CTA mapping was operated on the 9 patients, the number and location of perforators, the length of pedicle, thickness of the flap were measured. The discrepancies between perforator mapped by preoperative CTA and by intraoperative exploration were compared using SPSS 20.0 software package for paired t test. RESULTS: The pedicle length was long, the diameter of the vascular pedicle matched the recipient vessel in the neck, with minor donor site complications. The length of pedicle, thickness of the flap and location of the medial sural artery perforators were not significantly different between CTA mapping and interoperative measurement, including the preoperative CTA mapping was precise. CONCLUSIONS: CTA can be used to map the perforators preoperatively and precisely, which is beneficial for surgeons to harvest the flap and reduce surgical risks.

Key words: Medial sural artery perforator flap, Applied anatomy, CT angiogrphy, Microsurgery

中图分类号:

R782.2

方早, 金淑芳, 田卓炜, 张陈平, 何悦. CT血管造影在腓肠内侧动脉穿支皮瓣血管定位中的应用[J]. 中国口腔颌面外科杂志, 2015, 13(3): 220-225.

FANG Zao, JIN Shu-fang, TIAN Zhuo-wei, ZHANG Chen-ping, HE Yue. A preliminary study on application of CT angiography in accurate mapping of the free medial sural artery perforator[J]. China J Oral Maxillofac Surg, 2015, 13(3): 220-225.

参考文献

[1] Fujino T. Contribution of the axial and perforator vasculature to circulation in flaps [J]. Plast Reconstr Surg, 1967, 39(2): 125-137.
[2] Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la C&#x0dbc0;&#x0dd61;mara A, et al. The medial sural artery perforator free flap [J]. Plast Reconstr Surg, 2001, 108(6): 1609-1615.
[3] Chen SL, Chen TM, Dai NT, et al. Medial sural artery perforator flap for tongue and floor of mouth reconstruction [J]. Head Neck, 2008, 30(3): 351-357.
[4] 杨秀军, 程芙蓉, 李巍. 股骨头动脉血供的CTA评价 [J]. CT理论与应用研究, 2011, 20(4): 565-571.
[5] 毛驰, 张雷, 崔秋菊, 等. 游离腓肠内侧动脉穿支皮瓣修复头颈部缺损的初步研究 [J]. 中华口腔医学杂志, 2011,46(12):742-746.
[6] Kim HH, Jeong JH, Seul JH, et al. New design and identification of the medial sural perforator flap: an anatomical study and its clinical applications [J]. Plast Reconstr Surg, 2006, 117(5): 1609-1618.
[7] Potparic Z, Colen LB, Sucur D, et al. The gastrocnemius muscle as a free-flap donor site [J]. Plast Reconstr Surg, 1995, 95(7):1245-1252.
[8] Okamoto H, Sekiya I, Mizutani J, et al. Anatomical basis of the medial sural artery perforator flap in Asians [J]. Scand J Plast Reconstr Surg Hand Surg, 2007, 41(3): 125-129.
[9] Hallock GG. Anatomic basis of the gastrocnemius perforator-based flap [J]. Ann Plast Surg, 2001, 47(5): 517-522.
[10] 谭石, 李敬府, 白志勇, 等. 彩色多普勒超声在腓肠内侧动脉穿支皮瓣术前评估中的应用 [J]. 中国临床医学影像杂志, 2012, 23(7): 488-491.
[11] Alonso-Burgos A, García-Tutor E, Bastarrika G, et al. Preoperative planning of deep inferior epigastric artery perforator flap reconstruction with multislice-CT angiography: imaging findings and initial experience [J]. J Plast Reconstr Aesthet Surg, 2006, 59(6): 585-593.
[12] Higueras Suñé MC, L&#x0dbc0;&#x0dda9;pez Ojeda A, Narv&#x0dbc0;&#x0dda6;ez García JA, et al. Use of angioscanning in the surgical planning of perforator flaps in the lower extremities [J]. J Plast Reconstr Aesthet Surg, 2011, 64(9): 1207-1213.