三维超声造影血管重建在穿支皮瓣术前评估中的应用

Application of contrast enhanced ultrasound combined with three-dimensional reconstruction in the preoperative evaluation of perforators flap

目的 研究三维超声造影血管重建在穿支皮瓣术前评估中的有效性.方法 对拟行穿支皮瓣手术的10例患者,术前进行三维超声造影穿支血管重建,获得血管影像的解剖信息和血流动力学特征,包括鉴别穿支类型、体表出肌点、穿支数量及走行,以及血流最大收缩速度和抵抗指数.首选穿支类型简单、走行平直、直径粗大,且峰值流速快的血管为皮瓣供血血管,设计并切取皮瓣;术中将实际情况与术前检测进行核实比较.结果 本组共10例患者,在拟切取皮瓣的区域由超声探查到的18个穿支均在术中得到证实,其余穿支血管因术中不需要显露,而未在术中得到证实,所有皮瓣术中情况与术前检测基本一致,皮瓣切取操作顺利,术后存活良好.结论 三维超声造影血管重建能够获得丰富的穿支血管解剖信息和直观的三维立体空间影像,并能实现穿支的体表定位,在穿支皮瓣手术中发挥着重要作用.

Objective To study the usefulness of contrast-enhanced ultrasound combined with 3D recon- struction in the preoperative evaluation of perforators flap. Methods Ten patients who would performed the perforator flap operation were undertaken contrast-enhanced uhrasound combined with 3D reconstruction before operation, obtaining the anatomical information of vascular imaging and hemodynamic characteristics, including the perforator type, the position where the vessel perforates from muscle into adipose layer, the number and the course of perforator vessel, peak systolic velocity and resistance index. The straighter and bigger perforators of type were the first choices. Based on this information, the preferred perforator and the ideal donor site were se- lected for the flap harvesting. During surgery, the accuracy of preoperative imaging data was compared with the surgical findings. Results Of 10 patients, 18 perforators detected by ultrasound were confirmed during surgery except for those which were unnecessary for showing. The entire intraoperative situation and the preoperative de- tection were basically identical. The flaps were harvested smoothly and postoperative survival was well. Conclu- sion Contrast-enhanced ultrasound combined with 3D reconstruction provides anatomic information of perfora- ting branches, precisely the perforator location and intuitional 3D-image in space, which plays a very important role in perforator flap surgery.