吲哚菁绿血管造影在评估皮瓣末梢血运中的应用研究

Application study of indocyanine green angiography in evaluating the peripheral blood supply of skin flaps

目的 探讨皮瓣修复手术中应用吲哚菁绿血管造影(indocyanine green anigiography,ICGA)以增加皮瓣移植成活率和减少皮瓣术后并发症的可行性。方法 自2019年3月至2021年3月,西安交通大学附属西安市中心医院烧伤整形美容外科收治78例患者,按来院先后顺序分为对照组40例,观察组38例。对照组进行传统的皮瓣移植术;观察组在皮瓣移植术前及术中进行ICGA,以评价皮瓣的血运情况,并根据造影结果调整手术方案。结果 对照组均通过传统的手术方式进行皮瓣手术,其中有8例皮瓣尖端在术中出现血运障碍,给予相应处理后完成手术;其余32例按术前设计顺利结束手术。观察组进行ICGA后均未出现造影相关并发症,其中有3例根据ICGA结果调整手术方案,顺利完成手术;其余35例按术前设计顺利结束手术。所有患者均随访6个月。观察组与对照组术后皮瓣血供异常(χ^(2)=0.212,P=0.645)及皮瓣相关并发症发生率(χ^(2)=0.749,P=0.387)的比较,差异无统计学意义。结论 术前进行ICGA,可对随意皮瓣的设计起到一定的辅助作用;在皮瓣手术中应用ICGA能够实时的观测皮瓣血流灌注情况,起到帮助调整皮瓣手术方案的作用。

Objective To explore the feasibility of applying indocyanine green angiography (ICGA) before and during the operation to evaluate the blood supply of the flap and adjust the surgical plan in flap repair surgery to increase the survival rate of flap transplantation and reduce complications after flap surgery.Methods From March 2019 to March 2021,the clinical data of 78 patients admitted to the Department of Burn Plastic and Cosmetic Surgery of Xi’an Central Hospital Affiliated to Xi’an Jiaotong University were randomly selected and divided into control group of 40 cases and experimental group of 38 cases according to the order of admission.The control group underwent traditional flap transplantation,and the experimental group underwent ICGA before and during the operation to evaluate the blood supply of the flap and adjust the surgical plan based on the results of the angiography.Results All 38 patients in the experimenta group had no angiography-related complications after ICGA.Among them,3 cases adjusted the operation plan according to the ICGA results and ended the operation smoothly,the remaining 35 cases ended the operation smoothly according to the preoperative design.In the control group,all flap operations were performed by traditional surgical methods.Among them,8 cases of flap tips had blood flow disorders during the operation,and the operations were terminated after corresponding treatments,the remaining 32 cases were successfully completed according to the preoperative design.All patients were followed up for 6 months.There was no statistically significant difference between the observation group and the control group in the incidence of postoperative flap blood supply abnormalities (χ^(2)=0.212,P=0.645) and flap related complications (χ^(2)=0.749,P=0.387).Conclusion ICGA before operation can play an auxiliary role in the design of random skin flap,the application of ICGA angiography in flap surgery can evaluate the blood perfusion of the flap in real time,which is helpful to adjust the flap operation plan.