腹壁下动脉穿支皮瓣血管磁共振血管成像研究及其在乳房再造中的应用

目的:腹壁下动脉穿支(Deep Inferior Epigastric Perforator,DIEP)皮瓣已经成为乳房再造的重要手段之一,本研究通过磁共振血管成像(magnetic resonance angiography,MRA)对腹壁下动脉穿支进行三维成像,研究其血管走形及穿支情况,并在临床中加以应用。方法:本研究中共11位单侧乳房缺如的女性患者,均为乳腺癌乳房切除术后,术前1周以内行腹部磁共振血管成像检查,根据血管三维成像的结果,术前在皮肤表面标记血管穿支的位置,与手术中实际寻找到的血管穿支点进行比较,得出定位准确率及定位距离误差。结果:术前MRA对腹壁下动脉穿支的三维成像与手术实际操作相比,血管穿支定位距离误差为(1.08±0.51)mm,定位腹壁下动脉血管的准确率为100%。结论:MRA应用于DIEP皮瓣是一种无创、有效、简便的辅助手段,有利于提高手术效率,减少手术时间及并发症的产生。

Study on deep inferior epigastric perforator magnetic resonance angiography and clinical application on breast reconstruction

Objective Deep inferior epigastric perforator （DIEP） flaps have become the state of the art in breast reconstruction.We obtained the visualization of the superficial and deep vasculature of the abdomen using magnetic resonance angiography （MRA）,studied the arborization pattern within subcutaneous fat and the mapping of perforators at their emergence point,instructing the clinical application. Methods Eleven women were enrolled in this study,underwent preoperative evaluation using 1.5 -T MRA,perforator identification,emergence point and deep inferior epigastric artery branching type were performed.The accuracy in assessing perforator and mean error in distance measurement were counted. Results Accuracy in assessing perforator was 100% and mean error in distance measurement was （1.08 ±0.51）mm. Conclusions MRA preoperative evaluation is an untrauma,effective and convenient assistant method in the DIEP flap procedure,enhancing the efficiency and reducing the surgical time and complication rate.