胸肩峰动脉的超声检测及其在胸大肌肌皮瓣移植成形术中的应用价值

Application and value of ultrasonography in detection of thoracoacromial artery for designing musculocutaneous flap of pectoralis major muscle

目的对行胸大肌肌皮瓣移植成形术患者应用超声探测胸肩峰动脉,评估血管情况,配合临床制定手术方案。方法应用彩色多普勒超声检查16例准备行胸大肌肌皮瓣移植成形术患者和25例正常健康志愿者共66支胸肩峰动脉,观察胸肩峰动脉总干和胸肌支的走行,并测量血管内径(D)、收缩期血流峰值速度(Vmax)、舒张末期速度(Vmin)和阻力指数(RI)。结果胸肩峰动脉总干在锁骨中点稍外侧从腋动脉前壁发出,内径(2.24±0.35)mm;胸肌支垂直向下走行于胸大肌与胸小肌之间,内径(1.51±0.36)mm;约在乳头内上方向前移行为胸肌支的穿支。胸肩峰动脉为低速高阻血管,左侧与右侧胸肩峰动脉总干比较,D、Vmax、Vmin及RI差异均无统计学意义(t分别=0.95、0.83、0.09、0.69,P均>0.05);左侧与右侧胸肩峰动脉胸肌支比较,D、Vmax、Vmin及RI差异亦无统计学意义(t分别=0.58、0.72、1.52、0.92,P均>0.05)。结论术前利用超声能对胸肩峰动脉有一个全面了解,有利于术前设计正确的手术方案。

Objective To detect the thoracoacromial artery and evaluate vascular conditions in patients accepting musculocutaneous flap transplantation of pectoralis major muscle. Methods Sixty-six thoracoacromial artery were observed with color doppler ultrasound examination in 16 patients and 25 normal controls. Their diameter （D）, peak velocity in systole （Vmax）, end-diastolic velocity （Vmin） and resistive index （RI） were measured. Results The thoracoacromial artery was originated from the anterior wall of axillary artery and its inner diameter was （2.24±0.35）mm. The pectoral branches walked between pectoralis major and minor, and its inner diameter was （1.51±0.36）mm. The blood flowing characteristic of thoracoacromial artery was high RI and low velocity. There was no difference between left and right thoracoacromial artery in D, Vmax, Vmin and RI statistically （t= 0.95,0.83,0.09,0.69, P〉0.05）. There was also no difference between left and right pectoral branches in D, Vmax, Vmin and RI （t=0.58, 0.72, 1.52, 0.92, P 〉0.05）. Conclusions The color doppler ultrasound examination is a reliable method for evaluating the thoracoaeromial artery.