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COLOR-FLOW DUPLEX DOPPLER SCANNING STUDY IN THE TRAM FLAP PERFORATORS:A REPORT OF 94 CONSECUTIVE PATIENTS

OBJECTIVE: To investigate the location of transverse rectus abdominis musculocutaneous (TRAM) flap perforators on abdomen skin and the peak systolic flow velocities of the perforators. METHODS: A series of 94 consecutive patient’s TRAM flap perforators were detected by color-flow duplex Doppler scanning peroperatively. Perforator locations were tabulated on the abdomen skin according to their vertical position relative to the umbilicus and their lateral location relative to the abdominal midline. RESULTS: The perforators on both left and right side of TRAM flap were quite not symmetry. The peri-umbilical region contained 81.1% of the perforators. All perforators were detected with peak systolic flow velocities ranging from 5 to 81 cm/s. CONCLUSION: The preoperative color-flow Doppler localization of TRAM flap perforators improves the surgeon’s ability to design the flap in order to capture the dominant vessels, and select single- or double-pedicle and free TRAM flaps based on each patient’s individual characteristics.

Clinical application of ultrasound guided Fogarty balloon catheter in arterial crisis

Objective To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter. Methods Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years (mean, 32 years). The limb mutilation position was at knee joint in 3 cases, lower limb in 9 cases, ankle joint in 6 cases, elbow joint in 2 cases, forearm in 4 cases, and wrist joint in 3 cases. The arterial crisis happened at 2.5-18 hours (mean, 7.5 hours) after limb replantation surgery. Color doppler ultrasonography was used to diagnose the arterial thrombosis, finally the anastomotic thrombosis were found in 16 cases, non-anastomotic thrombosis in 7 cases, and combined thrombosis in 4 cases. All the thrombosis were deteced in the arteries with the length of 0.8-3.9 cm. Results No complication such as vascular perforation, rupture, air embolism, thromboembolism, wound infection, or sepsis happened after operation. Arterial crisis occurred again in 3 cases at 1.5-13.5 hours after limb replantation and treated by arterial exploration, 1 case was treated successfully; 2 cases had arterial occlusion and partial necrosis of limb, and got amputation treatment at last. The rest 24 cases survived with the incision healing by first stage. In the 24 cases, 1 case suffered from acute myonephropathic metabolic syndrome and corrected after hemodialysis; 1 case suffered from acute liver functional damage and corrected by comprehensive treatment of internal medicine. The 24 patients were followed up 7-38 months (mean, 11 months). At last follow-up, blood supply of the limb was good with normal skin temperature and improved sense of feeling, activity, and swelling. According to Chinese Medical Association of hand surgery to the upper extremity function assessment standard, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases with an excellent and good rate of 83.3%. Conclusion Ultrasound guided Fogarty balloon catheter treatment of posterior replantation of arterial crisis can accurately locate the thrombosis, get the thrombus fast and invasive minimally to avoid the blind and repeated thrombectomy, and obtain certain effectiveness.

Study on Evaluation of Hemodynamic Changes of Portal Veins in Patients with Liver Cirrhosis by Color Doppler

目的　分析彩色多普勒超声对肝硬化患者门静脉血流改变的评价作用。 方法　选择2010年1月－2011年4月收治的50例肝硬化患者作为观察组，其中代偿期患者27例，失代偿期患者23例；同时设置健康对照组50名，比较两组的门静脉内径（Dpv）、门静脉平均血流速度（Vpv）、门静脉血流量（Qpv）。 结果　观察组患者的Dpv增宽，Vpv减慢，Qpv减少，与对照组比较，差异均有统计学意义（P＜0.05）；且失代偿期患者的改变更为明显，与代偿期患者间差异有统计学意义（P＜0.05）。 结论　彩色多普勒超声检查门静脉血流改变可以对肝硬化患者进行初步确诊。

The Value of Color Doppler Flow Imaging in the Diagnosis of Iatrogenic Damaging Pseudoaneurysm

目的:探讨彩色多普勒超声在诊断冠状动脉造影术后引发的医源损伤性假性动脉瘤的临床价值。方法: 经股动脉穿刺,行冠状动脉造影术而发生的股动脉假性动脉瘤共39例,所有患者都采用高频彩色多普勒诊断仪,对动脉瘤的二维超声图像、彩色多普勒图像及脉冲多普勒图像进行分析。结果: 39例假性动脉瘤患者在穿刺部位动脉的一侧均显示一搏动性无回声区或混合性低回声区;彩色多普勒显示无回声区内呈涡流或旋转样血流信号,表现为一半红色一半蓝色;脉冲多普勒显示典型的双期双向频谱。39例假性动脉瘤彩色多普勒超声诊断完全明确。其中32例在彩色多普勒超声监控下行人工加压包扎修复。7例经血管外科手术修补治疗。结论: 彩色多普勒超声在诊断冠状动脉造影术后造成的医源损伤性假性动脉瘤,在观察动脉瘤的大小、形态、瘤体的结构,判断来源动脉破口定位上准确、简便、无创,且可在超声引导下行安全无创治疗,可作为该病诊断及治疗的首选方法。

Multiple factor analysis of intraorbital hemodynamic results in diabetic retinopathy

Objective To determine the affected factors of intraorbital hemodynamic results in diabetic retinopathy (DR) and the risk factors related to the occurrence of DR. Methods Posterior ciliary artery (PCA), central retinal artery (CRA), central retinal vein (CRV), and vortex vein (VV) of 68 patients with DR were measured by color Doppler flow image (CDFI). Thirty-one hemodynamic parameters, including systolic velocity, diastolic velocity, mean velocity, resistive index, pulsatility index and accelerative velocity of ophthalmic artery (OA), and other variates (blood pressure, blood sugar, gender, age, duration of the disease, and so on) were collected and clustered in a principal components analys is following a forward, stepwise logistic regression on these components. Results Nine principal components were extracted from 37 original variates, reflecting the velocity of OA, velocity of PCA, resistance of OA, velocity of CRA,resistance of CRA, resistance of PCA, time-related factor, venous drainage factor and gender factor, respectively. In the result of logistic regression, resistance of OA, velocity of CRA, resistance of PCA, time-related factor, and venous drainage factor were the risk factors related to DR. Conclusion The first risk factor affecting DR is time, and intraorbital hemodynamic abnormity influencing the development of diabetic retinopathy may be the increase of resistance of OA, decrease of velocity of CRA, decrease of resistance of PCA, and increase of venous drainage. (Chin J Ocul Fundus Dis，2004，20：98-100)

膝、腕关节滑膜超声在类风湿关节炎中的临床价值比较

摘要:目的:探讨类风湿性关节炎(RA)病人膝、腕关节滑膜关节滑膜的超声检查指标与RA临床指标的相关性。方法:通过高频超声及彩色多普勒超声对RA病人(50 例)的膝、腕关节的滑膜情况(包括滑膜厚度、关节积液程度、滑膜彩色血流分级)进行观察,并获取RA患者疾病活动度(DAS28)分值、炎症指标C反应蛋白(CRP)、红细胞沉降率(ESR)、标记性抗体抗瓜氨酸抗体(CCP)和类风湿因子(RF)滴度水平并对上述指标做相关分析。结果:①RA病人膝关节滑膜厚度、关节积液程度、滑膜血流信号分级等级与患者DAS28(r=0.35、r=0.38、rs =0.54,Plt;0.05)、CRP(r=0.41、r=0.45、rs =0.57,Plt;0.05)、ESR(r=0.38、r=0.42、rs=0.51,Plt;0.05)均呈正相关;腕关节滑膜厚度、滑膜血流等级信号与患者DAS28(r=0.55、rs=0.69,Plt;0.05)、CRP(r=0.53、rs =0.67,Plt;0.05)、ESR(r=0.48、rs=061,Plt;0.05)均呈正相关,且相关系数高于膝关节组;②膝关节组滑膜厚度与关节积液程度、滑膜血流分级等级均呈正相关(Plt;0.05),关节积液程度与滑膜血流分级呈正相关(Plt;0.05);腕关节组滑膜厚度与滑膜血流分级等级均呈正相关(Plt;0.05);③膝、腕关节之间仅滑膜血流信号等级成等级正相关(Plt;0.05)。结论:膝、腕关节滑膜超声能较好地观察类风湿性关节炎病人滑膜的病变,其指标能作为一种客观有效的评价疗效、判断疾病活跃性及评估预后的指标,尤其应该以腕关节作为RA病人的优选关节。

应用超声波评价冠状动脉旁路移植术患者脑缺血并发症的危险因素

目的 为减少冠状动脉旁路移植术(CABG)患者术后脑缺血并发症的发生,评价其危险因素. 方法 术前对连续施行CABG的65例患者常规行双功能彩色多普勒血流图象(CDFI)和经颅多普勒(TCD)检查,观察颈动脉和颅内动脉形态学和血流动力学指标的改变(包括颈动脉内膜厚度、斑块的发生、血管狭窄率等). 结果 CDFI检测异常57例(87.7%);颈内动脉狭窄gt;50%13例,其中单侧狭窄50%～69% 6例,双侧狭窄50%～69% 2例,双侧狭窄70%～99% 1例,一侧颈内动脉闭塞、一侧狭窄gt;50% 4例.TCD发现颅内动脉单支狭窄8例,多支狭窄25例.术后死亡2例(3.1%),围术期心肌梗死2 例.冠状动脉3支病变患者颈动脉内膜增厚和多发性斑块发生率明显高于2支病变患者(χ2=4.37, 8.56;P=0.034, 0.013). 结论 术前行CDFI和TCD检查对颈动脉和颅内动脉硬化病变是一种可行的无创筛选方法,对减少CABG患者脑缺血并发症,提高冠心病的外科治疗水平很有价值.

彩色多普勒超声在胆囊小隆起性病变中的诊断价值

目的 评价彩色多普勒超声在胆囊小隆起性病变中的诊断价值。 方法 2003年3月-2008年7月收治56例胆囊小隆起性病变患者，其中胆固醇息肉35例，胆囊炎性息肉8例，腺瘤7例，腺肌增生症4例，胆囊癌2例，观察病灶二维图像及彩血流分布及血流频谱特征，均经手术、病理证实。 结果 胆囊息肉常多发，基底窄或有蒂，CDFI不或很少显示血流信号。腺瘤单发为主，基底较宽或有蒂，CDFI不或很少显示血流信号；腺肌增生症（局限型）单发，基底较宽，CDFI不显示血流信号；胆囊癌基底宽，CDFI显示丰富血流信号，多普勒频谱呈低阻动脉频谱。 结论 彩色多普勒超声结合传统二维声像图对胆囊小隆起性病变有较高的诊断价值。

高频彩色多普勒超声诊断肌疝一例

诊断主动脉夹层动脉瘤的影像学比较

【摘要】　目的　讨论彩色多普勒超声、多层螺旋CT（multislice spiral CT，MSCT）及MRI对主动脉夹层动脉瘤（aortic disection，AD）的诊断价值，评价3种检查方式的优势与不足，为临床选择检查提供依据。　方法　回顾性分析2008年1月—2010年6月期间，32例经手术证实为AD患者的彩色多普勒超声、MSCT及MRI检查资料，并与术中所见及病理分型进行对比分析。　结果　术前彩色多普勒超声检出率为78.1%（25/32），诊断准确率为84%（21/25），MSCT及MRI检出率及诊断准确率均为100%。　结论　3种检查方法对AD术前均有较高的诊断价值，彩色多普勒超声术前诊断准确率及检出率低于MSCT及MRI，应存患者病情允许情况下，MSCT及MRI为首选检查方法，若病情危重则以床旁彩色多普勒超声为最佳检查方法，3种检查在临床应用上各有优势与不足，具体选择应视患者病情而定。