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腹壁浅动脉皮瓣的解剖学研究及其应用于头颈部修复的初步探讨

发布时间:2018-05-19 06:22

  本文选题:腹壁浅动脉 + 外科皮瓣 ; 参考:《蚌埠医学院》2011年硕士论文


【摘要】:目的:为腹壁浅动脉皮瓣的临床应用提供解剖学依据并探讨其在头颈部修复中的意义。 方法:尸体解剖:解剖常规福尔马林固定6个月以内的成年尸体标本10具,观察并测量腹壁浅动静脉的起源、位置、管径、走形、分支、分布及与周围血管的共干关系等,并模拟手术切取皮瓣1例。影像解剖:对60例健康志愿者的双侧下腹壁行彩色多普勒超声检测,观察、测量腹壁浅动静脉的出现率、管径、走形及平均流速等,并做相关分析。查阅国内外文献,结合目前头颈部缺损与修复的现状,对该皮瓣在头颈修复中的意义进行探讨并评价彩色多普勒超声在检测腹壁浅动脉皮瓣血供中的应用价值。 结果:人体解剖学研究的10具标本中,1具2侧腹壁浅动脉缺如;9具18侧标本在腹股沟水平均可见腹壁浅动脉,动脉平均管径为1.48mm,平均蒂长为4.80cm。11侧在起始处与周围血管形成共干。腹壁浅动脉走行与分支方式有4种,其中5侧为总干型,3侧为双分支型,7侧为单外侧支型,3侧为单内侧支型。仅有腹壁浅静脉伴行8侧,腹壁浅静脉和一对动脉伴行静脉同时出现12侧。10具20侧标本均可见腹壁浅静脉,平均管径2.33mm,,平均蒂长为5.45cm。超声多普勒检测的60侧正常人体下腹壁中,检测到腹壁浅动脉52侧,显示率:86.7%,余8侧中,6侧未检测到该血管,2侧检测到可疑血管信号,但连续性不佳。60侧腹壁浅静脉均在腹股沟韧带中点内侧检测到,由于其壁薄,易受压变形,未对管径进行测量。腹壁浅动脉起源平均管径(D1)为:1.73±0.22mm,越过腹股沟韧带管径(D2)为:0.81±0.16mm,收缩期流速为:23.08±6.83cm/s,阻力指数为:0.60±0.17。文献报道临床应用疗效满意,成功率达96.5%。 结论:1、腹壁浅动脉皮瓣可选择性的应用于头颈部多种软组织缺损修复。2、部分腹壁浅动脉管径较细,术者需要娴熟的显微吻合技术。3、超声多普勒超声能清晰的显示及定位动脉,可对皮瓣的术前筛选及设计提供准确、科学的依据。
[Abstract]:Objective: to provide anatomic basis for the clinical application of superficial abdominal artery flap and to explore its significance in the repair of head and neck. Methods: autopsy: 10 adult cadavers were fixed with formalin for less than 6 months. The origin, location, diameter, shape, branch, distribution and relationship with peripheral vessels of superficial abdominal arteriovenous vessels were observed and measured. The flap was removed by simulated operation in 1 case. Image anatomy: color Doppler ultrasound was performed on the bilateral lower abdominal wall of 60 healthy volunteers. The occurrence rate, diameter, shape and average velocity of the superficial arteriovenous vessels of the abdominal wall were observed and analyzed. According to the current situation of head and neck defect and repair, the significance of this flap in head and neck repair was discussed and the value of color Doppler ultrasound in detecting blood supply of superficial abdominal artery flap was evaluated. Results: the superficial abdominal artery was found in 9 of the 10 specimens of 10 specimens studied by human anatomy. The average diameter of the artery was 1.48 mm. The average pedicle length was the 4.80cm.11 side at the beginning and the peripheral blood vessel formed a common stem. There were 4 types of transversal and branching modes of superficial abdominal artery, of which 5 sides were total trunk type, 3 sides were double branching type, 7 sides were single lateral branch type and 3 sides were single medial branch type. There were only 8 superficial veins in the abdominal wall, 12 superficial veins and a pair of arterial veins in 20 sides of 10 patients. The average diameter was 2.33 mm and the average pedicle length was 5.45 cm. The superficial abdominal artery was detected in 52 sides of 60 normal human lower abdominal walls by ultrasound Doppler, with a display rate of 86.7%, and no suspicious vessel signal was detected in 2 sides of the remaining 8 sides. However, the superficial veins of 60 sides of the abdominal wall were detected on the medial side of the midpoint of the inguinal ligament. The diameter of the tube was not measured because the wall was thin and easily deformed. The mean diameter of the origin of the superficial abdominal artery was 1.73 卤0.22mm, the diameter of the inguinal ligament was 0.81 卤0.16mm, the velocity of contraction was 0.23.08 卤6.83cm / s, the resistance index was 0.60 卤0.17mm. It is reported that the clinical application is satisfactory, and the success rate is 96. 5%. Conclusion the superficial abdominal artery flap can be selectively used to repair multiple soft tissue defects in head and neck, and the diameter of some superficial abdominal arteries is thin. The technique of microanastomosis is needed. Ultrasound Doppler ultrasound can clearly display and locate the artery. It can provide accurate and scientific basis for the preoperative screening and design of the flap.
【学位授予单位】:蚌埠医学院
【学位级别】:硕士
【学位授予年份】:2011
【分类号】:R322

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