Application value of CTA combined with digital technology in the design of anterolateral thigh flap in repairing operative defect of head, neck and maxillofacial tumor resection
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摘要: 目的 探讨计算机断层扫描血管造影术(CTA)联合数字化技术在头颈颌面部肿瘤术后缺损患者股前外侧皮瓣血管解剖及术前术中皮瓣设计中的价值。方法 选取我院2018年4月-2019年4月收治的25例头颈颌面部肿瘤术后缺损患者为研究对象，术前CTA、数字化技术明确血管解剖学等相关情况，实施手术，通过一致性分析CTA、数字化技术及CTA联合数字化技术在头颈颌面部肿瘤术后缺损股前外侧皮瓣穿支定位中的价值，比较三种检查方式诊断效能。结果 术前CTA检查发现：皮瓣供区管径>0.8 mm的肌间隔穿支有26支，>1.0 mm的肌皮穿支有17支；术中实际证实管径>0.8 mm的肌间隔穿支有27支，>1.0 mm的肌皮穿支有17支；故术前检查准确率分别为96.29%和100.00%；另外，利用数字技术对旋股外侧动脉进行了测定。降支起始位置、血管直径、穿支方向、可切蒂的最大长度均与术中实际观察相符，入组全部患者均顺利实施皮瓣切取及修复。有2例皮瓣发生血管危象，经处理后存活。术后对患者进行3~12个月随访，24例皮瓣外形良好，1例创面皮瓣臃肿，择期行二期修薄术后外形满意。25例头颈颌面部缺损患者中使用CTA穿支定位检查(+)18例，灵敏度90.00%，特异度60.00%，准确率84.00%，Kappa=0.500。25例头颈颌面部缺损患者中使用数字化技术穿支定位检查(+)19例，灵敏度86.36%，特异度66.67%，准确率84.00%，Kappa=0.412。25例头颈颌面部缺损患者中CTA联合数字化技术穿支定位检查(+)21例，灵敏度95.45%，特异度66.67%，准确率92.00%，Kappa=0.621。CTA联合数字化技术在头颈颌面部肿瘤患者穿支定位中的准确性均明显高于单一方式(P < 0.05)。结论 CTA在头颈颌面部肿瘤缺损患者穿支定位中具有较好的应用价值，另外联合数字化技术可提高在股前外侧皮瓣血管解剖及术前术中皮瓣设计中的准确性，有利于手术的实施。Abstract: Objective To explore the value of computed tomography angiography (CTA) combined with digital technology in the vascular anatomy of the anterior thigh flap in patients with operative defects after head, neck and maxillofacial tumor operation, and in the design of preoperative and intraoperative flaps.Methods Twenty-five cases of patients with postoperative defect after head, neck and maxillofacial tumor surgery admitted to our hospital from April 2018 to April 2019 were selected. Preoperative CTA and digital technology were used to clarify vascular anatomy and other related conditions, and the operation was carried out. Consistency analysis was applied to evaluate the value of CTA, digital technology and CTA combined digital technology in the localization of anterolateral thigh perforator flap with operative defects after head, neck and maxillofacial tumor resection, and the diagnostic efficacy of the three methods was compared.Results The preoperative CTA examination revealed that there were 26 intermuscular perforators with a diameter greater than 0.8 mm in the flap donor site, and 17 musculocutaneous perforators with a diameter greater than 1.0 mm. During the operation, it was actually found that there were 27 intermuscular perforators with a diameter greater than 0.8 mm and 17 musculocutaneous perforators with a diameter greater than 1.0 mm. The accuracy rates of Pre-operative examination were 96.29% and 100.00%, respectively.In addition, the lateral femoral circumflex artery determined by digital technology. The starting position of the descending branch, the diameter of the vessel, the direction of the perforating vessel, and the maximum length of the pedicle that can be cut were consistent with the actual observation during the operation. All the patients in the group successfully underwent flap removal and repair. After the operation, 2 skin flaps suffered from vascular crisis, and survived under the managements of anticoagulation, lifting of restraint, and massage. The rest of the flaps survived smoothly. The patients were followed up for 3-12 months postoperatively. Twenty-four cases of skin flaps had good appearance. One case had swollen wound And the appearance of the skin flap was satisfactory after elective secondary thinning. Among the 25 patients with head and neck defects, in the perforator location examination, 18 cases were detected by CTA, with a sensitivity of 90.0%, a specificity of 60.0%, an accuracy of 84.0%, and Kappa=0.500. 19 cases was detected by digital technology, with a sensitivity of 86.36%, a specificity of 66.67%, a accuracy rate of 84.00%, and Kappa=0.412. 21 cases was detected by CTA combined with digital technology, with a sensitivity of 95.45%, a specificity of 66.67%, a accuracy of 92.00%, and Kappa=0.621. The accuracy of CTA combined with digital technology in the perforator positioning of patients with head and neck tumor defects was significantly higher than that of the single method(P < 0.05).Conclusion CTA has good application value in the positioning of perforator in patients with head, neck and maxillofacial tumor defects. In addition, the combination of CTA and digital technology can improve the accuracy of the vascular anatomy of the anterior thighflap and the design of the preoperative and intraoperative flaps, which is beneficial to surgery clinical implementation.
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表 3 CTA联合数字化技术在头颈颌面肿瘤缺损患者穿支定位中的价值
CTA联合数字化技术 穿支 合计 (+) (-) (+) 21 1 22 (-) 1 2 3 合计 22 3 25 
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表 4 三种方式穿支定位效能比较
方式 灵敏度/% 特异度/% 准确率/% CTA 90.00 60.00 84.00 数字化技术 86.36 66.67 84.00 CTA联合数字化技术 95.452) 66.67 92.001)2) 与CTA比较，1)P < 0.05；与数字化技术比较，2)P < 0.05。
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