吲哚菁绿荧光造影和彩色多普勒超声在穿支皮瓣术前血管定位中临床应用

发布时间：2018-06-10 11:43

本文选题：穿支血管 + 彩色多普勒超声　；参考：《昆明医科大学》2016年硕士论文

【摘要】：目的：通过比较吲哚菁绿荧光造影(Indocyanine green video angiography, ICGVA)和彩色多普勒超声(Color Doppler Ultrasound, CDUS)在术前穿支血管定位的准确性,探讨吲哚菁绿荧光造影和彩色多普勒超声各自的优点和缺点,及在穿支皮瓣手术中的应用价值。方法：选取2014年10年月至2016年4月成都军区昆明总医院骨科,需做穿支皮瓣的26例患者,所有患者术前分别用彩色多普勒超声和吲哚菁绿荧光造影对皮瓣供区进行穿支血管定位,其中腓动脉穿支皮瓣12例,旋股外侧动脉穿支皮瓣14例；术中对切取皮瓣范围内标定血管进行探查,分析两种方法定位穿支血管准确性。皮瓣面积最大16 cm×20cm,皮瓣最小3 cm×7 cm,皮瓣穿支血管的直径最细0.5 mm,最大1.8 mm；修复部位：手部及前臂创面9例,足踝创面17例。结果：术后所有皮瓣均成活,供区16例直接关闭缝合,10例通过部分植皮；术后18例获得随访,时间为3-9个月,皮瓣质地优良,供区愈合良好。在皮瓣切取范围内,12例腓动脉穿支皮瓣,CDUS术前检查发现穿支血管24条,应用ICGVA术前发现穿支血管25条,术中证实为26条。14例旋股外侧动脉穿支皮瓣,CDUS术前检查发现穿支血管39条,应用ICGA术前发现穿支血管32条,术中证实为36条。腓动脉穿支皮瓣的CDUS准确率92.31%与ICGA准确率96.15%(t=0.36, p=1.000.05),两组差异无统计学意义。旋股外侧动脉穿支皮瓣的CDUS准确率92.31%与ICGVA准确率88.89%(t=0.26, p=0.700.05),两组差异无统计学意义。结论：1.吲哚菁绿荧光造影和彩色多普勒超声是皮瓣穿支血管术前定位的两种有效方法,定位准确,真实可靠。2.彩色多普勒超声可以探查穿支起源、血管直径、血流参数,但有假阳性及假阴性,且需要有经验的彩超医师操作。3.吲哚菁绿荧光造影是一种体表定位方式,显影迅速、定位准确,可以反映穿支血管的灌注范围,且由术者自己操作完成。但作为一种表面成像技术,不能反应深部源动脉的走形及毗邻。
[Abstract]:Objective: to compare the accuracy of Indocyanine green video angiography, ICGVA (Indocyanine green video angiography,) and Color Doppler Ultrasound (CDUSS) in the localization of perforating vessels before operation, and to explore the advantages and disadvantages of indocyanine green fluorescence contrast imaging and color Doppler ultrasound. And its application value in perforating branch flap operation. Methods: from October 2014 to April 2016, 26 patients with perforating flaps were selected from Department of Orthopaedics, Kunming General Hospital of Chengdu military region. The perforating branch of the flap was located by color Doppler ultrasound and indocyanine green fluorescein angiography. The perforating branch flap of peroneal artery in 12 cases and the perforating branch flap of lateral circumflex femoral artery in 14 cases. The accuracy of two methods for locating perforating vessels was analyzed. The area of the flap was 16 cm 脳 20 cm, the minimum was 3 cm 脳 7 cm, the diameter of the perforating branch of the flap was 0.5 mm and 1.8 mm, the repair site was 9 cases of hand and forearm wounds and 17 cases of foot and ankle wounds. Results: all the flaps survived after operation, 16 cases of donor area closed suture directly through partial skin grafting, 18 cases were followed up for 3 to 9 months, the skin flap texture was good and the donor area healed well. In 12 cases of peroneal artery perforating branch flap, 24 perforating vessels were detected by CDUS before operation and 25 perforating vessels were detected by ICGVA. Thirty-nine perforating vessels were found by CDUS in 14 cases with perforating branch flap of lateral circumflex femoral artery, 32 perforating vessels were found before operation with ICGA, and 36 vessels were confirmed during operation. The accuracy of CDUS in peroneal artery perforator flap was 92.31%, and the accuracy rate of ICGA was 96.150.36 and 1.000.05, respectively. There was no significant difference between the two groups. The accuracy of CDUS was 92.31% in lateral circumflex femoral artery perforator flap and 88.89% in ICGVA. There was no significant difference between the two groups. Conclusion 1. Indocyanine green fluorescence angiography and color Doppler ultrasound are two effective methods for preoperative localization of perforating vessels of the flap. The localization is accurate, true and reliable. Color Doppler ultrasound can detect the origin of perforating branches, vascular diameter, blood flow parameters, but there are false positive and false negative, and require experienced color Doppler surgery. Indocyanine green fluorescein angiography is a kind of body surface localization method, which can reflect the perfusion range of perforating vessels and is performed by the operator himself. However, as a surface imaging technique, it can not reflect the shape and contiguity of the deep source artery.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R622

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