超声三维造影在穿支皮瓣血管术前定位中的应用

Application of three-dimensional contrast enhanced ultrasound to preoperative localization of the vessel perforators of skin flap

目的：探讨超声三维造影在穿支皮瓣术前定位的临床应用价值。方法：2011年8月~2014年3月间在我院应用游离或带蒂的穿支皮瓣修复组织缺损和器官再造手术患者20例,其中10例观察组患者术前采用超声三维造影检查：重点获得穿支血管三维解剖和出肌点信息。10例对照组患者术前采用手持多普勒超声诊断仪选择穿支皮瓣,探测穿支血管出肌点。术中将实际观察情况与术前检测结果进行核实比较。结果：术后观察组患者皮瓣均成活,穿支血管均能直观显示三维走行及与周围组织的位置关系,出肌点定位精准,术中证实超声所见,术前穿支标记点和术中真实位置的距离在6 mm以内。对照组穿支出肌点与术前定位差异较大,且出现两例假阳性。结论：超声三维造影能准确、清晰地显示穿支血管的解剖学信息,为临床手术提供了明显的便利。

Objective ：To assess the value of clinically applying three dimensional contrast enhanced ultrasound （3D CEUS ）to perforator flap surgery. Methods ：Twenty patients undergone reconstruction of the soft tissue defects or organ with either free perforator flap or pedicled perforator flap between Au- gust 2011 and March 2014 in our hospital were allocated to two groups（ n = 10 for each）. The experimental group received presurgical 3D ultrasonic angi- ography to determine the 3D anatomy of perforator vessel and donor site, and the control group were given handheld Doppler ultrasound to determine the perforator flap and donor site. Intraoperative findings were compared with the presurgical predication. Results： The perforator flaps were survived in the ex- perimental group, and the flaps better displayed three dimensional shape and position with the adjacent tissue. The donor site was accurately localized, and the results were commensurable with intraoperative findings with a deviation in 6 mm. Whereas the deviation was relatively larger between presurgical ima- ging and intraoperative finding,and false positive occurred in two cases. Conclusion ：3D CEUS can vividly and accurately display the anatomical configura- tion for the perforator flaps, which ensures successful perforator flap surgery.