發(fā)布時間：2018-02-13 01:15

  本文關(guān)鍵詞： 腹壁下動脈穿支 彩色多普勒超聲 穿支選擇 穿支皮瓣　出處：《上海交通大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：背景：腹壁下動脈深穿支（DIEP）皮瓣在全球乳腺惡性腫瘤根治術(shù)后，再次塑造乳房的手段中，正發(fā)揮越來越顯著的作用。然而，由于腹壁下動脈深穿支解剖變異較大，術(shù)前對穿支血管進(jìn)行探查和評估，進(jìn)而從眾多穿支中選出優(yōu)勢穿支，對手術(shù)具有重要的意義。常用于術(shù)前探查該穿支血管的影像學(xué)技術(shù)包括MDCTA，MRA，以及彩色多普勒超聲等。彩色多普勒超聲由于成本低，無放射無侵入性，便于顯示細(xì)小血管，能夠有效提供血流信息等優(yōu)勢，是首選檢查手段。然而DIEP優(yōu)勢穿支的彩色超聲下術(shù)前選擇標(biāo)準(zhǔn)至今仍未見報(bào)道。 目的：本研究擬比較穿支血管不同術(shù)前檢查手法的優(yōu)劣，并通過統(tǒng)計(jì)學(xué)手段明確DIEP各解剖、血流動力學(xué)參數(shù)的影響因素，明確術(shù)前對優(yōu)勢穿支的超聲下選擇標(biāo)準(zhǔn)。 方法：1.影像學(xué)比較：對臨床DIEP皮瓣患者行MDCTA及彩色多普勒超聲檢查，觀察其腹壁下動脈穿支各參數(shù)，并將其與術(shù)中所見進(jìn)行比較。2.穿支影響因素研究：對52例臨床DIEP皮瓣乳房再造患者進(jìn)行基本信息統(tǒng)計(jì)及術(shù)前彩色多普勒超聲檢查，通過統(tǒng)計(jì)學(xué)方法，對DIEP各參數(shù)及其影響因素進(jìn)行研究分析。3.優(yōu)勢DIEP穿支選擇標(biāo)準(zhǔn)的探究：對37例雙蒂雙穿支DIEP皮瓣乳房再造患者進(jìn)行研究，，對其DIEP血管口徑、收縮期血流峰值（PS）、阻力指數(shù)（RI）與術(shù)后皮瓣轉(zhuǎn)歸的關(guān)系分別進(jìn)行回顧性分析，進(jìn)而探索DIEP的優(yōu)勢穿支選擇標(biāo)準(zhǔn)。 結(jié)果：1.彩色多普勒超聲是術(shù)前DIEP穿支血管探查可靠手段。2.DIEP穿支數(shù)量與患者BMI及腹部手術(shù)史顯著相關(guān)；口徑與患者年齡、BMI、二手煙接觸史顯著相關(guān)；血管PS與該血管RI呈顯著相關(guān)，受患者年齡、腹部手術(shù)史影響顯著；血管RI與患者穿支內(nèi)徑有顯著相關(guān)，受患者年齡、BMI、腹部手術(shù)史影響顯著。3.皮瓣轉(zhuǎn)歸受DIEP內(nèi)徑影響顯著，受PS、RI影響不顯著。 結(jié)論：1.彩色多普勒超聲因其無創(chuàng)傷、無輻射、費(fèi)用低、準(zhǔn)確、可重復(fù)等眾多優(yōu)點(diǎn)，在DIEP術(shù)前穿支血管探查中的應(yīng)用和價值不容否認(rèn)。2.臨床工作中，有理由將BMI及最粗穿支口徑嚴(yán)格納入DIEP皮瓣術(shù)前患者篩查標(biāo)準(zhǔn)。3.在DIEP的術(shù)前穿支選擇中，血管穿深筋膜處內(nèi)徑為第一選擇標(biāo)準(zhǔn)，其次為解剖結(jié)構(gòu)，最次為血流動力學(xué)參數(shù)。
[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.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R737.9

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本文編號：1506990