乳房动脉CTA扫描与重建技术在缩胸手术术前规划中的应用

Application of CTA Scanning and Reconstruction of Breast Arteries in Preoperative Planning of Breast Reduction Surgery Megamasts

目的 探讨乳房动脉CTA扫描与重建技术对于缩胸手术术前规划的临床价值与意义。方法 收集2018年5月至2021年7月西京医院及西安大兴医院整形外科拟进行缩胸手术的患者60例(其中在西京医院进行CTA检查55例,大兴医院CTA检查5例),进行术前乳房CTA扫描,将CTA原始数据导入佳能VITREA4.0版本后处理工作站,应用Vessel-Tools软件对乳房内的供血动脉进行提取并三维数字建模,标注每一个患者乳房内动脉乳晕乳头器官的主要供血动脉来源并测量血管末端直径,使用ORS 3.0软件进行乳房体积测量。建模后的图像和测量数据由放射科医师与整形外科医师进行联合术前规划。每一个病例4~9个月后进行随访观察,统计患者乳晕乳头复合区(NAC)的坏死率和并发症情况。结果 在60例患者中,共提取重建到血管206条。随访患者中没有1例出现NAC坏死情况及其他并发症或感染。结论 在进行缩胸手术之前进行乳房动脉CTA检查并进行血管提取重建,可以在手术前对乳房内动脉进行观测,明确NAC区的乳房走行和主要血供情况,可以避免术中伤及NAC供血动脉,保护乳晕乳头功能,提高手术成功率。

Objective To explore the clinical value and significance of breast artery CTA scanning and reconstruction technology for preoperative planning of breast reduction surgery. Methods From May 2018 to July 2021,60 patients who planned to undergo breast reduction surgery in the plastic surgery department of Xijing Hospital and Xi’an Daxing Hospital(including 55 cases of CTA examination in Xijing Hospital and 5 cases of CTA examination in Daxing Hospital) were collected and operated. Pre-breast CTA scan,import CTA raw data into Canon VITREA4.0 version post-processing workstation,use VesselTools software to extract and 3D digital model the blood supply arteries in the breast,and mark the main internal mammary arteries,areola and papillary organs of each patient Source the blood supply artery and measure the diameter of the end of the blood vessel. Use ORS 3.0 software for breast volume measurement. The modeled images and measurement data are planned by radiologists and plastic surgeons for joint preoperative planning. Each case was followed up 4-9 months later,and the necrosis rate and complications of the patients’ areola nipple complex(NAC) were counted. Results In 60 patients,a total of 206 blood vessels were extracted and reconstructed. None of the follow-up patients had NAC necrosis and other complications or infections. Conclusion Carry out breast artery CTA examination and vascular extraction and reconstruction before breast reduction surgery. The internal mammary artery can be observed before surgery to clarify the breast course and main blood supply in the NAC area,which can avoid injury to the NAC supply artery during the operation.,Protect the function of the areola nipple and improve the success rate of surgery.