CT血管造影辅助设计的个性化股前外侧皮瓣在修复舌癌术后缺损中的应用

Application of individualized anterolateral thigh flap( ALTF) designed by computed tomography angiography( CTA) for tongue reconstruction after resection of tongue carcinoma

目的:探讨CT血管造影(CTA)定位股前外侧皮瓣穿支血管辅助设计的个性化股前外侧皮瓣(ALTF)在舌癌术后缺损修复中的效果。方法:纳入舌鳞状细胞癌患者21例,术前采用CTA定位患者股前外侧皮瓣穿支血管并根据检查结果模拟设计个性化的ALTF,术中应用ALTF行软组织缺损重建修复。结果:21例手术均顺利完成,术中所见血管走行与术前CTA显示均一致;切取皮瓣面积6.0 cm×5.0 cm^11.0 cm×8.5 cm;其中20例皮瓣存活,2例皮瓣发生血管危象,经手术探查后,1例皮瓣恢复正常,1例皮瓣未能抢救成功,皮瓣坏死。术后随访6~36月,1例患者术后18个月死于肿瘤远处转移,其余患者均无瘤存活,移植皮瓣存活情况良好,舌外形、咀嚼功能、吞咽功能、语言功能恢复满意。结论:术前CTA可精确定位股前外侧皮瓣穿支血管,利用CTA辅助设计的个性化股前外侧皮瓣修复软组织缺损可取得满意的效果。

Objective： To evaluate the clinical applicability of CT angiography（CTA） for locating the perforator vessels of anterolateral thigh flap（ALTF） and the effects of individualized ALTF designed by CTA for the reconstruction of the soft tissue defects of tongue after the resection of tongue carcinoma. Methods： 21 patients with tongue squamous cell carcinoma underwent CTA for locating the perforator vessels of ALTFs and for the design of individualized ALTFs before operation. The patients underwent soft tissue defect reconstruction with individualized ALTFs after tumor removal. Results： All the operations came off as preoperative designed, the intraoperative findings of the blood vessel alignment were consistent with the preoperative CTA results. The size of flaps was 6.0 cm × 5. 0 cm - 11.0 cm × 8.5 cm. 20 ALTFs survived, 2 ALTFs appeared vascular crisis, 1 remained survival and the other was necrotic after surgical exploration. During 6 - 60 months of follow- up, the survival condition of flaps and the wound healing condition were both satisfactory. 1 patient died because of distant metastasis 18 months after operation. 20 patients reminded free of carcinoma and satisfied with the reconstructive effects of chewing, swallowing and linguistic function. Conclusion： CTA can accurately locate perforator vessels for the design of individualized AFLT. AFLT designed by CTA is an ideal choice for the reconstruction of postoperative soft tissue defects after resection tongue carcinoma.