3D-CTA在腓动脉穿支皮瓣修复舌癌术后软组织缺损中的应用

许操; 王书芹; 胡恺; 宋培军; 吴志刚; 陈默; 孙悦; 李建成

doi:10.16766/j.cnki.issn.1674-4152.001954

3D-CTA在腓动脉穿支皮瓣修复舌癌术后软组织缺损中的应用

doi: 10.16766/j.cnki.issn.1674-4152.001954

许操¹,
王书芹²,
胡恺³,
宋培军⁴,
吴志刚³,
陈默³,
孙悦³,
李建成^3, ,

1.
蚌埠医学院口腔医学院，安徽蚌埠 233000
2.
蚌埠医学院第一附属医院医学影像科，安徽蚌埠 233004
3.
蚌埠医学院第一附属口腔颌面外科，安徽蚌埠 233004
4.
蚌埠医学院第一附属整形烧伤科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究项目 KJ2019A0374

详细信息

通讯作者:
李建成，E-mail：ljc7426@163.com

中图分类号: R739.86
计量
- 文章访问数: 222
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- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-25
- 网络出版日期: 2022-02-16

Application of 3D-CTA in peroneal artery perforator flap for repairing postoperative soft tissue defect of tongue carcinoma

1.
Department of Stomatology, Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的随着影像学技术的发展，可视化穿支皮瓣制取日益成熟，通过三维CT血管造影(3D-CTA)在腓动脉穿支皮瓣修复舌癌术后软组织缺损中的临床应用效果分析，为腓动脉穿支皮瓣设计及临床应用提供新方法。方法选取2019年1月—2020年6月蚌埠医学院第一附属医院口腔颌面外科收治的12例舌鳞状细胞癌患者(男性8例，女性4例，年龄36~73岁)，术前根据三维重建后的CTA检查结果进行腓动脉穿支的测量，选取符合移植条件的穿支血管，根据术前数据资料在术中对腓动脉穿支进行血管定位后应用腓动脉穿支皮瓣修复舌部软组织缺损。术后按时定期进行随访，通过观察有无肿瘤复发、转移、供区小腿运动功能等，来评价患者术区与供区的功能恢复情况。结果 12例患者术中腓动脉穿支均成功进行定位并顺利完成手术，所有移植穿支皮瓣均存活；1例患者术后皮瓣渗血，经急诊探查止血后恢复良好。移植皮瓣平均制取时间为47 min，血管蒂长度平均为6.2 cm。术后9个月，12例患者张口度Ⅲ度，咀嚼、言语基本恢复正常；术后12个月，12例患者下肢供区小腿恢复良好，无明显的运动不适。结论术前3D-CTA能准确的提供腓动脉穿支的解剖特征，为术中腓动脉穿支皮瓣的制取提供良好的影像学支撑，可以在腓动脉穿支皮瓣修复舌癌术后软组织缺损的应用中取得良好的效果。
- 三维CT血管造影 /
- 舌癌 /
- 腓动脉 /
- 穿支皮瓣
Abstract: Objective With the development of imaging technology, the visual perforator flap is becoming more and more mature. By analyzing the clinical application effect of 3D-CTA in the peroneal perforator flap to repair the soft tissue defect after tongue cancer surgery, it provides the basis for the design and clinical application of the peroneal perforator flap. Methods Total 12 patients with tongue squamous cell carcinoma (8 males and 4 females, aged 36-73 years) were selected from the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College from January 2019 to June 2020. The peroneal artery perforators were measured according to the CTA results after three-dimensional reconstruction before operation, and the perforators that met the transplantation conditions were selected. According to the preoperative data, the peroneal artery perforator flap was used to repair the soft tissue defect of the tongue. Follow-up was conducted on time and regularly after the operation to evaluate the functional recovery of patients at the operative and donor sites by observing whether there was tumor recurrence, metastasis, and the calf motor function at the donor site. Results The peroneal artery perforator flaps of 12 patients were successfully located and operated. All the grafted perforator flaps survived. One patient's skin flap oozed blood after operation, and recovered well after emergency investigation and hemostasis. The average preparation time of the grafted skin flap was 47 min, and the average length of the vessel pedicle was 6.2 cm. After 9 months, 12 patients with open mouth Ⅲ degrees, chewing and speech basic returned to normal. Twelve months after the operation, the lower leg of 12 patients in the lower limb donor area recovered well without obvious movement discomfort. Conclusion Preoperative 3D-CTA can accurately provide the anatomical characteristics of peroneal artery perforator, provide good imaging support for the preparation of peroneal artery perforator flap, and achieve good results in the application of peroneal artery perforator flap to repair postoperative soft tissue defects of tongue cancer.
- 3D-CTA /
- Tongue cancer /
- Peroneal artery /
- Perforators flap

HTML全文

图 1 术前口内病灶及腓动脉穿支的影像学设计

注：A为病灶位于右侧舌腹；B为供区小腿3D-CTA图像；C为腓动脉B2穿支血管蒂长度；D为腓动脉及B2穿支血管直径；E为腓动脉B2穿支穿出点相对于腓骨头的解剖位置。a为腓动脉主干；b1、b2、b3为腓动脉穿支；c为腓骨头至穿出点的垂直距离；d为穿出点至腓骨头的直线距离。

下载: 全尺寸图片幻灯片

图 2 术中腓动脉穿支设计、穿支探查、皮瓣切取及病灶修复

注: A为术中B2穿支穿出点设计；B为术中B2穿支定位；C为皮瓣制取完成；D为受区皮瓣就位。

下载: 全尺寸图片幻灯片

图 3 术后腓动脉穿支皮瓣移植受区、供区恢复情况

注：A为口内皮瓣术后1年；B为供区小腿术后6个月。

下载: 全尺寸图片幻灯片

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