彩色多普勒超声在评估口腔颌面部移植皮瓣存活中的临床应用

Clinical application of high frequency color Doppler ultrasonography in evaluating the survival of transplanted oral and maxillofacial flaps

目的探讨口腔颌面部肿瘤切除皮瓣移植重建术后,高频彩色多普勒超声在预测评估皮瓣存活情况中的临床应用。方法回顾性分析自2017年9月至2020年9月于首都医科大学附属北京友谊医院行口腔颌面部肿瘤切除及游离皮瓣移植修复重建术的患者10例。使用高频彩色多普勒超声监测移植皮瓣处重建血管的走行、内径、动脉收缩期峰值流速、血管内部及周围回声变化,评估判断皮瓣血管状态,并结合临床观察皮瓣颜色及皮温,判定皮瓣存活情况。结果10例患者均出现不同程度皮肤水肿,其中9例超声可显示吻合动、静脉血管(9/10),1例未显示。术后出现并发症4例,其中1例术后超声检查无法显示吻合血管,该患者术后24 h内临床肉眼观察未出现皮瓣颜色改变及皮温下降,肉眼观察至术后第7天,出现皮温降低、皮瓣颜色异常,最终发生皮瓣坏死。其余9例均未发生皮瓣坏死。结论高频彩色多普勒超声可监测皮瓣移植术后动、静脉吻合支血管情况,对于评估及预测口腔颌面部肿瘤切除后移植皮瓣存活情况具有一定价值。

Objective To investigate the clinical application of high frequency color Doppler ultrasonography in predicating and evaluating the survival of flaps used for reconstruction in the oral and maxillofacial region after tumor resection.Methods A retrospective analysis was performed on ten patients who underwent oral and maxillofacial tumor resection and tissue flap repair and reconstruction at Beijing Friendship Hospital Affiliated to Capital Medical University from September 2017 to September 2020.High frequency color Doppler ultrasonography was used to monitor the movement,inner diameter,peak systolic velocity(PSV),and internal and peripheral echo changes of the reconstructed vessels in the transplanted flap.At the same time,the color and skin temperature of the flap were observed clinically to evaluate the status of the vessels and the survival of the flap.Results All the ten patients showed different degrees of skin edema;anastomosis of arteriovenous vessels could be displayed in nine(9/10)cases,and could not in one.Postoperative complications occurred in four cases;in one of these cases,the anastomosis could not be displayed after surgery,the skin temperature decreased,the flap color was abnormal within 7 days after surgery,and the flap necrosis occurred finally.The other nine patients did not have flap necrosis,flap color change,or flap temperature reduction.Conclusion High frequency color Doppler ultrasound can be used to monitor the anastomosis of arteriovenous vessels after flap transplantation,and it has appreciated value in evaluating the survival of flaps transplanted after the resection of oral and maxillofacial tumors.