CT血管造影在延期DIEP皮瓣乳房重建术中的应用研究

徐华; 刘莺; 张亦; 王庭亮; 王涛; 何金光; 罗杰; 董莉萍; 王海蓉; 董佳生; 徐元兵

doi:10.19401/j.cnki.1007-3639.2022.02.004

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CT血管造影在延期DIEP皮瓣乳房重建术中的应用研究

论著 | 更新时间：2025-12-31

- CT血管造影在延期DIEP皮瓣乳房重建术中的应用研究
- Application of CT angiography in delayed DIEP flap breast reconstruction
- 中国癌症杂志 2022年32卷第2期页码：125-133
- 作者机构：
  
  1. 上海交通大学医学院附属第九人民医院整复外科,上海 200011
  2. 武汉科技大学附属孝感医院甲状腺乳腺外科,湖北孝感 432100
- 作者简介：
  
  XU Yuanbing E-mail: 443430731@qq.com
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2022.02.004
  中图分类号： R737.9
- 收稿：2021-10-20，
  
  纸质出版：2022-02-28
- 稿件说明：
移动端阅览
徐华, 刘莺, 张亦, 等. CT血管造影在延期DIEP皮瓣乳房重建术中的应用研究[J]. 中国癌症杂志, 2022,32(2):125-133.

Hua XU, Ying LIU, Yi ZHANG, et al. Application of CT angiography in delayed DIEP flap breast reconstruction[J]. China Oncology, 2022, 32(2): 125-133.
徐华, 刘莺, 张亦, 等. CT血管造影在延期DIEP皮瓣乳房重建术中的应用研究[J]. 中国癌症杂志, 2022,32(2):125-133. DOI： 10.19401/j.cnki.1007-3639.2022.02.004.

Hua XU, Ying LIU, Yi ZHANG, et al. Application of CT angiography in delayed DIEP flap breast reconstruction[J]. China Oncology, 2022, 32(2): 125-133. DOI： 10.19401/j.cnki.1007-3639.2022.02.004.

摘要

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 angiography

CTA）在延期DIEP皮瓣修复乳腺癌术后乳房缺损中的应用价值。

方法：

选取2016年1月

#x02014;2021年1月于上海交通大学医学院附属第九人民医院整复外科进行延期DIEP皮瓣乳房重建手术患者298例。将其中92例患者术前采用彩色多普勒超声检测进行皮瓣穿支评估设定为超声对照组（US组）

206例患者设定为观察组（CTA组）;术前采用CTA进行皮瓣穿支评估

将CTA数据导入HOROS软件分析

进行术前皮瓣优势穿支的选择

明确穿支血管直径、肌肉内走行方式及穿出点位置等解剖信息

从而指导手术。分析比较两组病例术前定位穿支数量、术中采用穿支数量、抉择穿支时间、穿支解剖时间、供区皮瓣获取时间、皮瓣重量、总手术时间

以及术后并发症发生率（腹部切口感染率、脂肪坏死率、二次手术探查率及皮瓣完全坏死率）

并进行两组病例影像手术一致率比较。结果：298例患者进行延期DIEP皮瓣乳房重建手术

皮瓣存活率为99.33%（296/298）。两组病例术前定位穿支数量[观察组（2.90

#x000b1;1.13）

对照组（3.21

#x000b1;1.46）

]

差异有统计学意义（P

0.05）。供区皮瓣获取时间[（50.05

#x000b1;10.94）min

（84.8

#x000b1;15.44）min

]

差异有统计学意义（

0.001）。两组病例在术后并发症发生率相比

差异无统计学意义（P

0.05）。在二次手术探查率的比较中

CTA组低于US组（P

0.001）。对于具有腹部手术史患者

CTA组穿支解剖时间、总手术时间优于US组（P

0.001）。两组病例影像手术符合率分别为97.09%和43.48%

差异有统计学意义（P

0.001）。

结论：

在延期DIEP皮瓣乳房重建术中

CTA可以明显地缩短术中皮瓣穿支抉择时间及解剖时间

降低二次手术探查风险

具有较高的影像手术一致率

可以有效地指导手术。

Abstract

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

#x02019;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 po

int

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

#x000b1;1.13)

US group (3.21

#x000b1;1.46) (P

0.05). The acquisition time of donor flap was (50.05

#x000b1;10.94) min

(84.8

#x000b1;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.

关键词

Keywords

references

LIU C , ZHAO Z Y , GU X , et al . Establishment and verification of a bagged-trees-based model for prediction of sentinel lymph node metastasis for early breast cancer patients [J ] . Front Oncol , 2019 , 9 : 282 .

YANG B L , REN G S , SONG E W , et al . Current status and factors influencing surgical options for breast cancer in China: a nationwide cross-sectional survey of 110 hospitals [J ] . Oncologist , 2020 , 25 ( 10 ): e1473 - e1480 .

HADDOCK N T , DUMESTRE D O , TEOTIA S S . Efficiency in DIEP flap breast reconstruction: the real benefit of computed tomographic angiography imaging [J ] . Plast Reconstr Surg , 2020 , 146 ( 4 ): 719 - 723 .

SMIT J M , DIMOPOULOU A , LISS A G , et al . Preoperative CT angiography reduces surgery time in perforator flap reconstruction [J ] . J Plast Reconstr Aesthet Surg , 2009 , 62 ( 9 ): 1112 - 1117 .

TONG W M , DIXON R , EKIS H , et al . The impact of preoperative CT angiography on breast reconstruction with abdominal perforator flaps [J ] . Ann Plast Surg , 2012 , 68 ( 5 ): 525 - 530 .

SANDBERG L J . Tracing: a simple interpretation method for the DIEP flap CT angiography to help operative decision-making [J ] . Plast Reconstr Surg Glob Open , 2020 , 8 ( 11 ): e3218 .

ROZEN W M , BHULLAR H K , HUNTER-SMITH D . How to assess a CTA of the abdomen to plan an autologous breast reconstruction [J ] . Gland Surg , 2019 , 8 ( Suppl 4 ): S291 - S296 .

谢庆平 , 穆籣 , 刘元波 , 等 . 腹壁下动脉穿支皮瓣专家共识 [J ] . 中华显微外科杂志 , 2020 , 43 ( 5 ): 417 - 423 .

XIE Q P , MU L , LIU Y B , et al . Expert consensus of inferior epigastric artery perforator flap [J ] . Chin J Microsurg , 2020 , 43 ( 5 ): 417 - 423 .

WILKINS E G , HAMILL J B , KIM H M , et al . Complications in postmastectomy breast reconstruction: one-year outcomes of the mastectomy reconstruction outcomes consortium (MROC) study [J ] . Ann Surg , 2018 , 267 ( 1 ): 164 - 170 .

郝爽 , 吴炅 . 腹壁下深血管穿支皮瓣在乳房重建应用中的技术难点与要点 [J ] . 中华内分泌外科杂志 , 2021 , 15 ( 5 ): 449 - 453 .

HE S , WU J . Technical difficulties and key points of subabdominal deep vascular perforator flap in breast reconstruction [J ] . Chin J Endocrine surg , 2021 , 15 ( 5 ): 449 - 453 .

DELLACROCE F J , DELLACROCE H C , BLUM C A , et al . Myth-busting the DIEP flap and an introduction to the abdominal perforator exchange (APEX) breast reconstruction technique: a single-surgeon retrospective review [J ] . Plast Reconstr Surg , 2019 , 143 ( 4 ): 992 - 1008 .

刘元波 , 朱珊 , 臧梦青 , 等 . 穿支皮瓣研究领域的新技术、新方法 [J ] . 中华整形外科杂志 , 2019 , 35 ( 9 ): 835 - 846 .

LIU Y B , ZHU S , ZANG M Q , et al . New methods and technologies in the field of perforator flap studies [J ] . Chin J Plast Surg , 2019 ( 9 ): 835 - 846 .

KHAN U D , MILLER J G . Reliability of handheld Doppler in planning local perforator-based flaps for extremities [J ] . Aesthetic Plast Surg , 2007 , 31 ( 5 ): 521 - 525 .

KEHRER A , HEIDEKRUEGER P I , LONIC D , et al . High-resolution ultrasound-guided perforator mapping and characterization by the microsurgeon in lower limb reconstruction [J ] . J Reconstr Microsurg , 2021 , 37 ( 1 ): 75 - 82 .

SU W J , LU L G , LAZZERI D , et al . Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning [J ] . Plast Reconstr Surg , 2013 , 131 ( 1 ): 80 - 93 .

ROZEN W M , GARCIA-TUTOR E , ALONSO-BURGOS A , et al . Planning and optimising DIEP flaps with virtual surgery: the Navarra experience [J ] . J Plast Reconstr Aesthet Surg , 2010 , 63 ( 2 ): 289 - 297 .

MASIA J , CLAVERO J A , LARRAÑAGA J R , et al . Multidetector-row computed tomography in the planning of abdominal perforator flaps [J ] . J Plast Reconstr Aesthet Surg , 2006 , 59 ( 6 ): 594 - 599 .

TEUNIS T , VAN VOSS M R H , KON M , et al . CT-angiography prior to DIEP flap breast reconstruction: a systematic review and meta-analysis [J ] . Microsurgery , 2013 , 33 ( 6 ): 496 - 502 .

WAGNER R D , DOVAL A F , MEHRA N V , et al . Incidental findings in CT and MR angiography for preoperative planning in DIEP flap breast reconstruction [J ] . Plast Reconstr Surg Glob Open , 2020 , 8 ( 10 ): e3159 .

WEUM S , MERCER J B , DE WEERD L . Evaluation of dynamic infrared thermography as an alternative to CT angiography for perforator mapping in breast reconstruction: a clinical study [J ] . BMC Med Imaging , 2016 , 16 ( 1 ): 43 .

THIMMAPPA N , BHAT A P , BISHOP K , et al . Preoperative cross-sectional mapping for deep inferior epigastric and profunda artery perforator flaps [J ] . Cardiovasc Diagn Ther , 2019 , 9 ( Suppl 1 ): S131 - S142 .

SUFFEE T , PIGNEUR F , RAHMOUNI A , et al . Best choice of perforator vessel in autologous breast reconstruction: virtual reality navigation vs radiologist analysis. A prospective study [J ] . J Plast Surg Hand Surg , 2015 , 49 ( 6 ): 333 - 338 .

PARRETT B M , CATERSON S A , TOBIAS A M , et al . DIEP flaps in women with abdominal scars: are complication rates affected? [J ] . Plast Reconstr Surg , 2008 , 121 ( 5 ): 1527 - 1531 .

ROOSTAEIAN J , YOON A P , SANCHEZ I S , et al . The effect of prior abdominal surgery on abdominally based free flaps in breast reconstruction [J ] . Plast Reconstr Surg , 2014 , 133 ( 3 ): 247e - 255e .

MALHOTRA A , CHHAYA N , NSIAH-SARBENG P , et al . CT-guided deep inferior epigastric perforator (DIEP) flap localization: better for the patient, the surgeon, and the hospital [J ] . Clin Radiol , 2013 , 68 ( 2 ): 131 - 138 .

彭文 , 吕春柳 , 周波 , 等 . 术前CT血管造影在腹壁下动脉穿支皮瓣乳房再造的应用现状和展望 [J ] . 中国修复重建外科杂志 , 2020 , 34 ( 7 ): 927 - 931 .

PENG W , LÜ C L , ZHOU B , et al . Application and prospect of preoperative computed tomographic angiography in deep inferior epigastric artery perforator flap for breast reconstruction [J ] . Chin J Reparative Reconstr Surg , 2020 , 34 ( 7 ): 927 - 931 .

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