超声影像在腹壁下动脉穿支选择中的应用

发布时间：2018-02-13 01:15

本文关键词： 腹壁下动脉穿支彩色多普勒超声穿支选择穿支皮瓣　出处：《上海交通大学》2014年博士论文　论文类型：学位论文

【摘要】：背景：腹壁下动脉深穿支（DIEP）皮瓣在全球乳腺恶性肿瘤根治术后，再次塑造乳房的手段中，正发挥越来越显著的作用。然而，由于腹壁下动脉深穿支解剖变异较大，术前对穿支血管进行探查和评估，进而从众多穿支中选出优势穿支，对手术具有重要的意义。常用于术前探查该穿支血管的影像学技术包括MDCTA，MRA，以及彩色多普勒超声等。彩色多普勒超声由于成本低，无放射无侵入性，便于显示细小血管，能够有效提供血流信息等优势，是首选检查手段。然而DIEP优势穿支的彩色超声下术前选择标准至今仍未见报道。目的：本研究拟比较穿支血管不同术前检查手法的优劣，并通过统计学手段明确DIEP各解剖、血流动力学参数的影响因素，明确术前对优势穿支的超声下选择标准。方法：1.影像学比较：对临床DIEP皮瓣患者行MDCTA及彩色多普勒超声检查，观察其腹壁下动脉穿支各参数，并将其与术中所见进行比较。2.穿支影响因素研究：对52例临床DIEP皮瓣乳房再造患者进行基本信息统计及术前彩色多普勒超声检查，通过统计学方法，对DIEP各参数及其影响因素进行研究分析。3.优势DIEP穿支选择标准的探究：对37例双蒂双穿支DIEP皮瓣乳房再造患者进行研究，，对其DIEP血管口径、收缩期血流峰值（PS）、阻力指数（RI）与术后皮瓣转归的关系分别进行回顾性分析，进而探索DIEP的优势穿支选择标准。结果：1.彩色多普勒超声是术前DIEP穿支血管探查可靠手段。2.DIEP穿支数量与患者BMI及腹部手术史显著相关；口径与患者年龄、BMI、二手烟接触史显著相关；血管PS与该血管RI呈显著相关，受患者年龄、腹部手术史影响显著；血管RI与患者穿支内径有显著相关，受患者年龄、BMI、腹部手术史影响显著。3.皮瓣转归受DIEP内径影响显著，受PS、RI影响不显著。结论：1.彩色多普勒超声因其无创伤、无辐射、费用低、准确、可重复等众多优点，在DIEP术前穿支血管探查中的应用和价值不容否认。2.临床工作中，有理由将BMI及最粗穿支口径严格纳入DIEP皮瓣术前患者筛查标准。3.在DIEP的术前穿支选择中，血管穿深筋膜处内径为第一选择标准，其次为解剖结构，最次为血流动力学参数。
[Abstract]:Background: the deep perforating branch of the inferior abdominal artery (DIEP) flap is playing a more and more important role in the reconstruction of breast after radical mastectomy. However, the anatomical variation of the deep perforating branch of the inferior abdominal artery is large. The perforating vessels were explored and evaluated before operation, and the superior perforating branches were selected from many perforating branches. The imaging techniques commonly used to detect the perforating vessels before operation include MDCTAA MRAand color Doppler ultrasound, etc. Because of its low cost, no radiation and no invasion, it is convenient to display small blood vessels. It is the first choice to provide blood flow information effectively. However, the preoperative selection criteria of DIEP superior perforating branches under color ultrasound are still not reported. Objective: the purpose of this study was to compare the advantages and disadvantages of different preoperative examination techniques for perforating vessels, and to determine the factors affecting the anatomy and hemodynamic parameters of DIEP by means of statistics, and to determine the criteria for selecting superior perforators by ultrasound before operation. Methods 1. Imaging comparison: the patients with clinical DIEP flap were examined by MDCTA and color Doppler ultrasound, and the parameters of perforating branch of inferior abdominal artery were observed. The factors influencing the perforating branch were compared with the intraoperative findings: 52 cases of clinical DIEP flap breast reconstruction were analyzed with basic information and preoperative color Doppler ultrasonography, and the results were analyzed by statistical method. Study on the parameters of DIEP and its influencing factors. 3. Study on the selection criteria of superior DIEP perforating branch: 37 patients with double pedicle double perforating DIEP flap were studied and their DIEP vessel caliber were analyzed. The relationship between peak systolic blood flow (PSV), resistance index (RI) and postoperative flap outcome was analyzed retrospectively, and the criteria for selecting superior perforating branches of DIEP were explored. Results 1. Color Doppler ultrasound was a reliable method for detecting the perforating branches of DIEP before operation. 2. The number of perforating branches of DIEP was significantly correlated with BMI and abdominal operation history, the caliber was significantly correlated with the age of patients and the history of exposure to secondhand smoke. There was a significant correlation between vascular PS and the vascular RI, which was significantly influenced by the patient's age and abdominal operation history, the vascular RI was significantly correlated with the perforator diameter, and was significantly affected by the patient's age, abdominal operation history, and the outcome of the flap was significantly affected by the inner diameter of DIEP. The effect of PSRI was not significant. Conclusion (1) because of its advantages of no trauma, no radiation, low cost, accuracy, repeatability and so on, color Doppler ultrasound can not be denied in the application and value of blood vessel exploration before DIEP. It is reasonable to include BMI and the thickest perforator caliber strictly in the preoperative screening criteria of DIEP flap. In the preoperative perforating branch selection of DIEP, the first choice is the diameter of the deep fascia, the second is the anatomical structure, and the second is the hemodynamic parameter.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.1;R737.9

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