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目的分析应用彩色多普勒血流成像(CDFI)技术辅助设计轴型肌皮瓣再造乳房的方法和疗效。方法根据乳腺癌手术放疗后局部病灶的特点,选择不同部位的轴型肌皮瓣对26例乳腺癌手术放疗后患者再造乳房,包括同侧背阔肌肌皮瓣、对侧横形腹直肌肌皮瓣和双侧横形腹直肌肌皮瓣,术前传统方法设计肌皮瓣后,应用具有高分辨率的多功能彩色多普勒血流成像仪检测轴型肌皮瓣供血动脉的起止点、外径、血管走向和长度等,根据检测结果再次设计肌皮瓣并转移至胸壁重建乳房,并将术中所见血管情况与 CDFI 的显示结果进行对照和比较。结果在 CDFI 探测肌皮瓣轴型血管中,发现有1例胸背动脉血流缓慢,管壁粗糙,动脉硬化较明显;其余血管探测结果均显示血流顺畅,管壁光滑,无栓塞、硬化现象,亦无血管缺如现象。CDFI 所检测供血动脉的起止点、外径、血管走向和解剖学层次均可清晰显示,与术中所见完全一致,术后26例轴型肌皮瓣全部成活,伤口愈合良好;再造的乳房在形态及感觉等方面均满意。结论 CDFI 对轴型肌皮瓣供血血管判断具有简单、直观和无创的特点,为确定轴型肌皮瓣移植术提供更为科学、准确的依据。
Objective To analyze the method and effect of using color Doppler flow imaging (CDFI) technique to assist the reconstruction of axial breast muscle flap. Methods According to the characteristics of local lesion after radiotherapy of breast cancer, different regions of axial myocutaneous flap were selected to reconstruct the breast of 26 breast cancer patients after radiotherapy, including the ipsilateral latissimus dorsi muscle flap, contralateral transverse rectus abdominis muscle Flap and bilateral transverse rectus abdominis myocutaneous flap, the muscle flap was designed by traditional preoperative method, and the starting and ending points of the feeding artery of axial myocutaneous flap were detected by multi-function color Doppler flow imaging with high resolution According to the test results, the myocutaneous flap was redesigned and transferred to the chest wall to reconstruct the breast. The blood vessel findings in the operation were compared with the results of CDFI. Results One case of thoracodorsal artery was found to have slow blood flow, rough wall and atherosclerosis in CDFI detection of myocutaneous axial vessels. The rest of the blood vessels showed smooth blood flow, smooth wall, no embolization and hardening Phenomenon, there is no lack of blood vessels phenomenon. CDFI detected the starting and ending points of blood supply artery, diameter, blood flow and anatomical level can be clearly displayed, and exactly the same as the intraoperative findings, all of the 26 cases of axial muscle flap survival after surgery, wound healing; reconstruction of the breast In form and feel satisfied. Conclusions CDFI is a simple, intuitive and noninvasive method to determine the blood supply of axial myocutaneous flap. It provides a more scientific and accurate basis for the determination of axial myocutaneous flap grafting.