术前颈部高分辨增强CT预判颏下皮瓣静脉回流走行对手术的指导意义

The guiding significance of predicting the venous route of submental flap by preoperative cervical high resolution enhanced multidetector computed tomography

目的通过术前颈部高分辨薄层增强CT预判颏下皮瓣(简称颏瓣)回流静脉的走行及周围毗邻关系,指导术中皮瓣回流静脉的解剖及保护。方法随机选取2020年3~9月首都医科大学附属北京同仁医院耳鼻咽喉头颈外科同一诊疗组医师拟行颏瓣修复手术患者16例,术前均行颈部增强CT扫描,跟随面静脉及颏下静脉逐层位置变化,判断皮瓣回流走行及毗邻关系并记录。依据术前预判术中寻找及保护皮瓣回流血管,判断两者吻合程度,并观察皮瓣愈合情况。结果 16例患者中除1例患者术前评估与术中不吻合,其余15例均完全吻合,吻合率为93.75%。术中回流于颈内静脉者5例(31.25%),其中1例同时有颈前静脉回流支;单纯回流颈外静脉6例(37.50%),单纯回流颈前静脉2例(12.50%),颈外及颈前同时有回流支者3例(18.75%)。结论术前颈部高分辨薄层增强CT的精细逐层阅读,能很好的预判颏瓣回流静脉的走行及周围毗邻关系,对术中皮瓣回流血管的解剖及保护有可靠的指导意义。

OBJECTIVE The preoperative cervical high-resolution thin-layer enhanced multidetector computed tomography(CT)was used to predict the course of the submental flap reflux vein and its adjacent relationship,so as to guide the anatomy and protection of the flap reflux vein during the operation.METHODS Sixteen patients who underwent submental flap reconstructive surgery by the same treatment team in our department from March to September 2020 were randomly selected.All patients were underwent cervical enhanced CT before operation,the facial vein and submental vein were viewed layer by layer,and the route of the vein of the flap and its adjacent anatomic structures were determined and recorded.According to preoperative prediction,the back-flow vessels of the flap were searched and protected in operations,the accuracy was assessed,and the healing of the flap was also observed.RESULTS Among the 16 patients,except for one patient who did not match the preoperative evaluation with the operation,the others were completely consistent,and the coincidence rate was 93.75%.The vein flowed to the internal jugular vein in 5 patients(31.25%),including 1 patient with anterior jugular vein branch,to the external jugular vein in 6 cases(37.50%),to the anterior jugular vein in 2 cases(12.50%),and to both external and anterior jugular vein in 3 cases(18.75%).CONCLUSION The delicate layer by layer reading of the cervical high-resolution thin-layer enhanced CT before operation can predict the reflux vein of the submental island flap and its surrounding structures,which has a good guiding significance for the anatomy and protection of the flap reflux vein during the operation.