MD-CT造影检查在整形外科穿支皮瓣术前设计中的应用研究［摘要］目的：探讨和评价多层螺旋CT(MDCT)造影检查在整形外科穿支皮瓣术前设计中的临床应用价值。方法：术前利用MDCT造影检查探查供区穿支血管情况，然后用特定的软件对数据进行分析与筛选，标记最理想的穿支。手术中用多普勒测定穿支血管的穿出点，解剖穿支，观察穿支血管位于的层次及走行，并与测定图像进行对比，以探讨MDCT的检查准确率及精确性，并根据受区组织缺损情况，设计穿支皮瓣或扩张预制的穿支皮瓣。结果：术屮观察到27条穿支血管，其位置均与术前测定相符,准确率100%,除一根穿支直径与术前显示不符，其余穿支的直径均与术前测定基本相符，精确度96.3%o皮瓣最大旋转角度可达180°,除1例皮瓣远端坏死，余成活良好，供区一期闭合，无继发畸形。结论：将MDCT造影检查应用于穿支皮瓣术前设计，相对丁•其他检查有明显优势，术前可提供准确而直观的影像，能显示出穿支血管的穿出点、管径及行程，大大提高了手术的效率、安全性与灵活性，口供区损伤小，可满足不同修复重建的需要，具有广泛的临床应用前景。［关键词1MD-CT造影检查；穿支皮瓣；术前设计；整形外科；多普勒［中图分类号1R622［文献标志码］A［文章编号］1008-6455(2015)18-0001-04PreoperativeMDCTangiographyintheplanningofperforatorflapsurgeryZHANGJun-yil,YANGSi-fen2,WANGChun-mei2(1.DepartmentofPlasticandCosmeticSurgery,BeijingTongrenHospital,CapitaiMedicalUniversity,Bejing,China100730；2.DepartmentofPlasticandAestheticSurgery,DongguanKanghuaHospital,Dongguan，GuangdongProvince,China523080)Abstract:ObjectiveToinvestigateandevaluatetheeffectivenessofMDCTanalysisfortheplanningofperforatorflapsurgery.MethodsWeusedspecificsoftwarefordataanalysisandscreeningwhichobtainedfromMDCTangiography,gettheimageswhichisavailabletohelpingpreoperativeplanning.ThroughtheMDCTangiography,wefindtheoptimalperforatortodesignaflapwhichcancurethedefectsafelyandperfectly.UsingDopplertomeasuretheperforatorvesselspiercingpointduringoperation,observingtheperforator'slocationandbranches,thencomparedwithMDCTangiography,thendesigntheperforatorflapaccordingtotherecipientsite.ResultsTheauthorspresented27perforatorsexploredwithMDCTangiography,andobservedthepiercingpointofthemintro~operationswiththeaccuracyof100%.Theoperationalsoleadstoagoodresult.Only1perforatorwasnotmatchedinitsdiameterandshowedthematchof96.3%fordiameters.Theoperationalsoleadstoagoodresult.Allthecasesweresatisfiedwithsurvivedwhichcanrotatedeven180°,exceptonecaseofdistalnecrosis,butwithbothgoodfunctionandappearance.Thedonorsitealsoclosedatthemeantimewithoutdeformity・ConclusionComparedwithothermethods,theMDCTangiographyismoreaccurateandaudio-visually.Itcanfacilitatetheoperationprocessanddecreasethecomplicationsverywell•Inthispaper,wewilldiscussabouttheeffectivenessofMDCTanalysisfortheplanningofperforatorflapsurgery.Itallowsappropriateselectionofthesizableperforatorwiththeshortestintramuscularandsuprafascialcoursepreoperativelyleadingtosaferandeasieroperationwithoptimaloutcomeinclinicalapplications.Keywords：MDCTangiography；perforatorflap；preoperativedesign；plasticsurgery；Doppler随着整形外科皮瓣技术的精细化及数据化，穿支皮瓣于术逐渐成为整形外科皮瓣手术的一个新思路。特别是2003年穿支皮瓣Gentconsensus（“根特”共识）的正式发表，极大地促进了穿支皮瓣的发展［1］。2011年经我国学者发表专家共识后定义穿支血管是指由源血管（sourcevessel）发出经肌肉或肌间隙穿出深筋膜到达皮下组织和皮肤的血管（包括穿动脉和穿静脉）⑵。穿支血管与主干血管不同，其个体之间的变异较大，术前常规需要用影像学的手段来检查穿支血管，辅助术前的设...