CT血管造影在延期DIEP皮瓣乳房重建术中的应用研究

背景与目的:乳房切除术后自体组织重建中,腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣越来越受到外科医师的关注,如何安全、有效地进行穿支血管定位、抉择、解剖是制备DIEP皮瓣最大的难点.探讨CT血管造影(computed tomographic angiograp...

Application of CT angiography in delayed DIEP flap breast reconstruction

Background and purpose:Deep inferior epigastric perforator(DIEP)is attracting increasing attention in breast reconstruction surgery.How to safely and effectively locate,choose and anatomize perforating vessels is a huge challenge for the preparation of DIEP flaps.This study aimed to explore the value of computed tomographic angiography(CTA)in delayed DIEP reconstruction after breast cancer surgery.Methods:From January 2016 to January 2021,298 patients underwent delayed DIEP flap breast reconstruction surgery in The Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.Among them,92 cases were set as the control group(US group),and the perforation of the flap was evaluated by ultrasound doppler before surgery.A total of 206 cases were selected as the observation group(CTA group).Preoperative perforation of the flap was evaluated by CTA,and the CTA data were imported into HOROS software for processing and analysis,so as to select the preoperatively dominant perforation of the flap and identify the anatomical information such as the diameter of perforation vessel,the way of intramural movement and the position of perforation point,for directing operation.The number of preoperative location perforations,number of intraoperative choice perforations,perforation choice time,perforation anatomy time,donor site flap acquisition time,flap weight,total operation time and incidence of postoperative complications(abdominal incision infection rate,fat necrosis rate,secondary surgical exploration rate and complete flap necrosis rate)were compared and analyzed between the two groups.And the consistency rate of imaging surgery was compared between the two groups.Results:All the 298 patients underwent delayed DIEP flap breast reconstruction,and the flap survival rate was 99.3%(296/298).The number of preoperative located perforations in the two groups was:CTA group(2.90±1.13)vs US group(3.21±1.46)(P<0.05).The acquisition time of donor flap was(50.05±10.94)min vs(84.8±15.44)min(P<0.001).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).In the comparison of the second surgical exploration rate,the CTA group was lower than the US group(P<0.001).For patients with a history of abdominal surgery,the perforator anatomical time and total operation time in the CTA group were better compared with the US group(P<0.001).The coincidence rates of imaging surgery in the two groups were 97.09%and 43.48%,respectively,with statistical significance(P<0.001).Conclusion:In delayed DIEP flap breast reconstruction,CTA can significantly shorten the choice time of flap perforation and anatomy time,reduce the risk of secondary surgical exploration and has a high rate of image surgery consistency,which can effectively guide the operation.