横行腹直肌肌皮瓣血流动力学的超声多普勒检测(附5例临床应用)

Ultrasound Doppler Used in Detecting TRAM Flap Hemodynamics and Clinical Application of 5 Cases

目的:探讨彩色多普勒超声对横行腹直肌肌皮瓣血流动力学的评估方法及其在乳房再造手术中的运用价值。方法:应用彩色多普勒高频探头对100例健康志愿者200条腹壁下动脉进行检测,同时,为5例乳腺癌术后乳房缺损患者行乳房再造手术。结果:200条腹壁下动脉均显示,PSV、D1各组间统计学差异显著(P<0.05)。横行腹直肌肌皮瓣乳房再造术5例,术后彩色多普勒超声皮瓣血流评估,皮瓣均存活,皮瓣血管通畅,再造乳房外观良好。结论:彩色多普勒超声检测腹壁下动脉是了解横行腹直肌肌皮瓣血运的直观、可靠且无创的方法;术前运用彩色多普勒超声对皮瓣血流进行评估,有利于筛选手术适应证,同时可指导肌皮瓣设计。

Objective To evaluate the application of color Doppler ultrasonography in detecting hemodynamics of transverse rectus abdominis musculocutaneous （TRAM） flap and used in breast reconstruction surgery after mastectomy. Methods Color Doppler ultrasonography was used in detecting 200 inferior epigastric arteries of 100 healthy volunteers and five breast cancer patients who after mastectomy accepted this method for breast reconstruction surgery, all of them used color Doppler ultrasound to assess blood flow mechanics of TRAM flap preoperatively. Results All 200 inferior epigastric arteries were shown, peak systolic velocity （PSV） and D1 in each group showed significant differences （P0.05）. Five patients accepted TRAM flap for breast reconstruction. After reconstruction surgery, flap survived and the reconstructed breasts showed a good appearance. Conclusion Color Doppler ultrasonography is a direct, reliable and noninvasive method in detecting hemodynamics of the TRAM flap. Using color Doppler ultrasonography to assess vascular dynamics of musculaocutaneous flap preoperatively is conducive screening surgical indications, at the same time guiding musculocutaneous flap design.