MDCTA血管三维重建技术在术前组织瓣营养血管评估中的应用

Clinical application of mnitidetector-row CT angiography for preoperative evaluation of nourished vessels of flaps

目的探讨多层螺旋CT血管造影（MDCTA）血管三维重建技术在术前组织瓣营养血管评估中的应用效果。方法依据初步手术方案进行术前组织瓣营养血管MDCTA血管三维重建，得到相关的血管走行、解剖位置及其穿支血管数量、位置、直径等信息，继而指导组织瓣的设计和手术方案的确定，在此基础上完成手术并观察手术效果。结果2006年8月至2007年8月于临床应用16例（24例次）。其中腹壁上、下动脉及穿支10例次，旋股外动脉降支及穿支4例次，胸背动脉及穿支10例次。其中有3例根据MDCTA血管三维重建结果改变了手术方案。16例术中组织瓣营养血管分布、走行、数量同术前三维血管图像完全吻合。术后组织瓣完全存活，手术效果满意。结论MDCTA三维血管重建技术为术前设计提供了准确、形象、直观的三维血管信息，提高了手术安全性及手术效果。

Objective To study the multi-row detector CT angiography （MDCTA） for preoperative evaluationof nourished vessels of flaps. Methods Preoperative MDCTA was performed to obtain the anatomic information about the nourished vessels of flaps, including ceassel course, localization, diameter and number of perforator artery. Then the flaps were designed according to the MDCTA results. The postoperative results were observed. Results From Aug 2006 to Aug 2007, 24 flaps（in 16 cases） were performed, including 10 flaps with deep inferior epigastric artery, 4 flaps with descending branch of the lateral circumflex femoral artery, and 10 flaps with thoracodorsal artery. The primary preoperative flap design was chaged according to the MDCTA results in 3 flaps. The distribution of the nourished vessels of flaps were exactly the same as the results of MDCTA. All the flaps were survived with satisfactory results. Conclusions MDCTA is a convenient and reliable technique for preoperative detection of nourished vessels of flaps. The MDCTA results can provide right and direct anatomic information for preoperative flap design to make sure the safty and good results of surgery.