夏丽女 王刚 郑有卯

[摘要] 目的 探討彩色多普勒超声（CDS）联合多层螺旋CT血管造影（MDCTA）在穿支皮瓣术前定位中的应用价值。方法 选取2017年12月至2019年12月在我院行旋股外侧动脉降支穿支皮瓣手术的患者78例，随机分为观察组和对照组，每组各39例，对照组予以MDCTA定位，观察组予以CDS联合MDCTA定位，比较两组术前定位与术中旋股外侧动脉降支穿支皮瓣穿出点的符合率、相差距离，同时观察术后1个月皮瓣的存活情况。 结果 观察组术前定位与术中利用穿支的符合率高于对照组，差异有统计学意义（P<0.05）;观察组术前定位与术中相差距离低于对照组，差异有统计学意义（P<0.05）;观察组术后1个月皮瓣存活率明显高于对照组，差异有统计学意义（P<0.05）。 结论 CDS联合MDCTA应用于穿支皮瓣术前定位中可以提高穿支血管定位的准确性，术后皮瓣存活率更高。

[关键词] 彩色多普勒超声;多层螺旋CT血管造影;旋股外侧动脉降支穿支皮瓣手术;定位

[中图分类号] R816.8          [文献标识码] B          [文章编号] 1673-9701（2021）06-0119-04

Application of color doppler ultrasound combined with multi-slice spiral CT angiography in preoperative localization of perforator flap

XIA Li′nyu1， 2   WANG Gang1， 2   Zheng Youmao1， 2

1.Department of Ultrasound， Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University， Taizhou  317000， China;2.Department of Ultrasound， Enze Hospital， Taizhou Enze Medical Center（Group） in Zhejiang Province， Taizhou  318050， China

[Abstract] Objective To explore the application value of color doppler ultrasound（CDS） combined with multi-slice spiral CT angiography（MDCTA） in preoperative localization of perforator flap. Methods Seventy-eight patients who underwent perforator flap of descending branch of lateral femoral circumflex artery in our hospital from December 2017 to December 2019 were selected and randomly divided into the observation group（n=39） and the control group（n=39）. MDCTA localization was given to the control group， and CDS combined with MDCTA localization was given to the observation group. The coincidence rate and distance gap of perforating point of perforator flap of descending branch of lateral femoral circumflex artery at preoperative localization and intraoperative localization were compared in the two groups， and the flap survival situation at 1 month after operation was observed. Results The coincidence rate of preoperative localization and intraoperative perforator use in the observation group was higher than that in the control group， with statically significant difference（P<0.05）; the distance gap between preoperative localization and intraoperative localization in the observation group was lower than that in the control group， with statically significant difference（P<0.05）; the flap survival rate at 1 month after operation in the observation group was higher than that in the control group， with statically significant difference（P<0.05）. Conclusion The application of CDS combined with MDCTA in preoperative localization of perforator flap can improve the accuracy of perforator vessel localization， with a higher survival rate of the postoperative flap.

[Key words] Color doppler ultrasound; Multi-slice spiral CT angiography; Perforator flap of descending branch of lateral femoral circumflex artery; Localization

穿支皮瓣是近段时间提出的概念，其指的是仅以管径0.5 mm左右细小的皮肤穿支血管进行供血的皮瓣[1]。由于此类皮瓣仅由皮肤和皮下组织组成，因此具有切取、转移灵活，损伤小等优点[2-3]。但由于穿支皮瓣供应血管极为细小，穿支血管发出的位置、数量和长度也有一定的变异，因此在术中追踪血管蒂的难度极大，常需要在术前利用影像学进行评估指导皮瓣设计，从而提高手术成功率，减少术后并发症发生率[4-6]。本研究观察了彩色多普勒超声（Color doppler ultrasound，CDS）联合多层螺旋CT血管造影（Multislice CT angiography，MDCTA）在穿支皮瓣术前定位中的应用价值，现报道如下。

1 资料与方法

1.1 一般资料

选取2017年12月至2019年12月在我院行旋股外侧动脉降支穿支皮瓣手术的患者78例。纳入标准[7]：①需行穿支皮瓣手术者;②年龄>18岁者。排……