显微外科血管吻合术中应用吲哚菁绿血管造影评价血管吻合通畅性的价值

摘要

Objective To explore the value of indocyanine green angiography in microsurgical vascular anastomosis for evaluating the patency of anastomosis.Methods Seventeen female patients undergoing breast reconstruction with autogenous tissue and vascular anastomosis with free flap from April 2015 to August 2016 in Peking University People's Hospital were enrolled.There were 13 anastomosis of inferior epigastric artery with thoracodorsal artery,12 anastomosis of inferior epigastric vein with thoracodorsal vein,7 anastomosis of inferior epigastric artery with internal thoracic artery,15 anastomosis of inferior epigastric vein with internal thoracic vein,1 anastomosis of deep femoral artery with thoracodorsal artery,1 anastomosis of deep femoral vein with thoracodorsal vein,1 anastomosis of deep femoral artery with internal thoracic artery,2 anastomosis of deep femoral vein with internal thoracic vein.Indocyanine green angiography was performed to evaluate the patency of anastomosis during operation.Results Thirty-eight times of indocyanine green angiography were performed in 17 patients during operation,no allergic reaction was observed.There were 22 arterial anastomosis and 30 venous anastomosis;1 arterial anastomosis and 1 venous anastomosis showed anastomotic leakage and were anastomosed again,the final patency rate was 100％.The patients were followed up for 1-17 months,all flaps survived without complications of avascular necrosis,infection or fat necrosis.Conclusion Intraoperative indocyanine green angiography can report real-time information in microsurgical vascular anastomosis and ensure the patency of anastomosis.%目的 探讨吲哚菁绿血管造影技术在显微外科血管吻合术中评价吻合通畅性的价值.方法 选取2015年4月至2016年8月于北京大学人民医院医疗美容科行游离皮瓣血管吻合术的女性患者17例,均应用自体组织进行乳房重建术.所有患者中腹壁下动脉与胸背动脉吻合13支,腹壁下静脉与胸背静脉吻合12支,腹壁下动脉与胸廓内动脉吻合7支,腹壁下静脉与胸廓内静脉吻合15支,股深动脉与胸背动脉吻合1支,股深静脉与胸背静脉吻合1支,股深动脉与胸廓内动脉吻合1支,股深静脉与胸廓内静脉吻合2支.所有患者血管吻合术中均应用吲哚菁绿血管造影观察吻合口的通畅性.结果 本组17例患者共吻合动脉22支,静脉30支.17例患者术中共进行吲哚菁绿血管造影38次,未出现过敏反应等造影并发症.22支动脉及30支静脉吻合中分别有1例动脉及l例静脉出现首次吻合血流不通畅,经过重新吻合后再次造影,显示吻合通畅(动静脉最终通畅率均为100％).患者术后均获得随访,随访时间1 ～17个月,皮瓣全部成活,未出现皮瓣缺血坏死、切口感染、脂肪液化等并发症.结论 显微外科血管吻合术中,应用吲哚菁绿血管造影可以准确地评价血管吻合口的通畅性,及时发现血管吻合异常,确保血管吻合的质量,从而避免皮瓣缺血坏死等血管相关并发症的发生.