CT血管成像三维重建技术在股前外侧穿支皮瓣修复头颈肿瘤术后缺损的应用

Application of CT angiography in design of anterolateral thigh perforator flap for reconstruction of defect after head and neck cancer resection

目的 探讨临床上应用CT血管成像（CTA）三维重建技术在用于头颈部肿瘤术后缺损修复的股前外侧穿支皮瓣（anterolateral thigh flap,ALTF）术前设计方面的优势.方法 回顾性分析四川省肿瘤医院头颈外科自2011年3月至2014年3月行头颈部肿瘤根治性切除后应用ALTPF移植修复的24例头颈部肿瘤患者的病历资料,这些患者按照术前穿支动脉的影像学检查方法分为彩超组和CTA组,每组12例.对比两组患者术中穿支血管吻合数、总手术时间、术后皮瓣相关并发症数等指标.结果 两组24例患者有1例皮瓣完全坏死,皮瓣总存活率为95.83％.CTA组术中所见穿支吻合12例/12例,高于彩超组术中所见穿支吻合8例/12例.CTA组总手术时间较彩超组明显短[单侧颈清扫：（6.80±0.53）比（8.39±0.75）h,双侧颈清扫：（8.79±0.97）比（10.96±0.26）h,均P＜0.05],术后CTA组患者发生皮瓣相关并发症（1/12）也少于彩超组（5/12）.结论 术前CTA能精确提供ALTPF穿支血管的解剖学信息特征,指导ALTPF术前设计,缩短手术时间和减少额外手术损伤,可作为股前外侧穿支皮瓣术前常规监测方式。

Objective To evaluate the benefits of CT angiography （CTA） in preoperative mapping of anterolateral thigh perforator flap （ALTPF） for reconstruction of defect after head and neck cancer resection.Methods Twenty-four patients underwent reconstruction of postoperative defect with ALTPF from March 2011 to March 2014 were retrospectively reviewed.According to the imaging methods used for examining perforating artery,these patients were divided into two groups：color Doppler flow imaging （CDFI）-group and CTA-group,12 patients in each group.The surgical results of all patients were evaluated for consistency in number of perforating artery,operation time and flap-related complications.Results Only one of all patients had complete flap necrosis,with an overall flap survival rate of 95.83%.All perforating branches showed with preoperative CTA were found in operation （12/12）,significantly higher than CDFI-group （8/12）.The mean operation time of CTA-group was significantly shorter than that of CDFI-group （Unilateral neck dissection：（6.80 ± 0.53） vs （8.39 ± 0.75） h,bilateral neck dissection：（8.79 ± 0.97） vs （10.96 ± 0.26）h,both P 〈0.05）.Flap-related complication occurred in one case in CTA-group,but in 5 cases in CDFI-group.Conclusions CTA can accurately provide anatomical information of perforator vessels and guide preoperative design of ALTPF to improve operative outcomes,including the decrease in operation time and surgical injury.