术前CT血管造影与三维重建技术辅助腹壁浅动脉穿支皮瓣修复口腔颌面部缺损的价值

Value of preoperative CT angiography and three-dimensional reconstruction technology assisted with the superfificial abdominal artery perforator flflap in repairing oral and maxillofacial defects

目的探讨术前CT血管造影(CTA)与三维重建技术辅助腹壁浅动脉穿支皮瓣修复口腔颌面部缺损的临床价值。方法选择口腔颌面部缺损的口腔癌患者82例为研究对象,以随机数表法分对照组与研究组,各41例。对照组行术前超声造影(CEUS)与三维重建技术辅助腹壁浅动脉穿支皮瓣修复口腔颌面部缺损修复,研究组行术前CTA与三维重建技术辅助腹壁浅动脉穿支皮瓣修复口腔颌面部缺损修复。比较2组术前腹壁浅动脉穿支皮瓣血管探查结果与术中探查结果一致性,记录2组制备皮瓣手术情况及腹壁浅动脉管径检查情况,比较2组围术期血液应激反应指标、咀嚼肌肌电活动及术后并发症情况。结果对照组38例、研究组39例行腹壁浅动脉穿支皮瓣修复,对照组术前CEUS三维重建探查腹壁浅动脉穿支皮瓣血管的灵敏度、特异度分别为97.30%、100%,研究组灵敏度、特异度分别为97.43%、100%。2组制备皮瓣时间、皮瓣大小、腹壁浅动脉厚度对比,差异均无统计学意义(P>0.05)。对照组术前测量的腹壁浅动脉管径高于术中实际测量值(P<0.05),研究组术前、术中测量的腹壁浅动脉管径比较,差异无统计学意义(P>0.05)。2组术前、术后3d去甲肾上腺素、肾上腺素、皮质醇水平比较,差异均无统计学意义(P>0.05)。2组术前、术后3个月静息时、最大力咬合时咬肌、颞肌肌电活动比较,差异均无统计学意义(P>0.05)。2组伤口均一期愈合,2组总并发症发生率比较,差异无统计学意义(P>0.05)。结论在探查腹壁浅动脉穿支皮瓣血管方面,术前CEUS三维重建技术、CTA三维重建技术与术中解剖结构探查一致率均较高,2种术前检查用于手术可取得相近效果。

Objective To explore the clinical value of preoperative CT angiography(CTA)and three-dimensional reconstruction technology assisted with the superficial abdominal artery perforator flap in repairing oral and maxillofacial defects.Methods A total of 82 oral cancer patients with oral and maxillofacial defects were selected as the research objects and divided into the control group and the study group according to random number table method,with 41 cases in each group.The control group was given preoperative contrast-enhanced ultrasound(CEUS)and three-dimensional reconstruction technology assisted with the supericial abdominal artery perforator flap to repair the oral and maxillofacial defects.The study group was given preoperative CTA and three-dimensional reconstruction technology assisted with the superficial abdominal artery perforator flap to repair the oral and maxillofacial defects.The consistency between the preoperative superficial abdominal artery perforator flaps and the results of the intraoperative exploration in the two groups was compared.And the operation status of the flap preparation and the inspection of the diameter of the abdominal wall superficial artery were recorded in the two groups.The perioperative blood stress response index,mastication electromyography activity,and postoperative complications between the two groups were compared.Results There were 38 cases and 39 cases of superficial abdominal artery perforator flap repair in the control group and in the study group,respectively.In the control group,the sensitivity and specificity of the preoperative CEUS and three-dimensional reconstruction technology for detecting the blood vessels of the superficial abdominal artery perforator flaps were 97.30%and 100%,respectively,and in the study group,the sensitivity and specificity were 97.43%and 100%,respectively.There were no statistically significant differences in the preparation time of flap,flap size,and thickness of the superficial abdominal artery between the two groups(P>0.05).The diameter of the superficial abdominal artery measured before operation in the control group was higher than the actual measurement during the operation(P<0.05).There was no statistically significant difference in the diameter of the superficial abdominal artery measured in the study group before and during the operation(P>0.05).There was no statistically significant difference in the levels of norepinephrine,epinephrine,and cortisol between the two groups before operation and at 3 days after operation(P>0.05).There was no statistically significant difference in the electromyographic activity of the masseter and temporal muscles between the two groups before operation,at rest 3 months after the operation,and at maximum force bite(P>0.05).The wounds of the two groups healed at first stage.There was no statistically significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion In the exploration of superficial abdominal artery perforator flaps,the preoperative CEUS and three-dimensional reconstruction technology,preoperative CTA and three-dimensional reconstruction technology,and intraoperative anatomical structure exploration have the high coincidence rate.The two preoperative examinations can achieve similar results when used for surgery.