腹部皮瓣乳房重建术后并发症及危险因素的研究  

Research on the postoperative complications and its risk factors of breast reconstruction with abdominal flaps

作　　者：尹健[1] 张婷[2] 张学慧[1] 李海欣[3] 肖春花[1] 曹旭晨[1] 张天浩[4] 

机构地区：[1]天津医科大学附属肿瘤医院乳腺科,300060 [2]北京解放军第三0九医院核医学科 [3]天津医科大学附属肿瘤医院流行病室,300060 [4]天津南开大学物理学院

出　　处：《中华外科杂志》2009年第24期1864-1867,共4页Chinese Journal of Surgery

摘　　要：目的探讨腹部皮瓣乳房重建的术后并发症及其相关危险因素。方法对2001年5月至2008年10月接受腹部皮瓣乳房重建的115例患者的资料和术后并发症情况进行回顾性分析。术后观察指标包括：皮瓣全部坏死、皮瓣部分坏死、脂肪坏死、腹壁疝、腹壁膨出、脂肪液化、感染。并对其术后并发症的相关危险因素进行分析。结果术后并发症的总发生率为17．4％（20／115），未出现皮瓣全部坏死、腹壁疝、腹壁膨出等严重并发症。皮瓣并发症为脂肪坏死6例（5．2％）、皮瓣部分坏死5例（4．3％）和感染1例（0．9％），供区并发症为脂肪液化8例（7．0％）和感染3例（2．6％）。年龄、肥胖和手术时机对于术后并发症的发生率无影响。吸烟者、既往有放疗史者、带蒂横行腹直肌肌皮瓣组术后并发症的发生率较高，但未达到统计学意义。结论在熟练掌握显微外科技术的情况下，实施腹壁下动脉穿支皮瓣乳房重建更有利于降低术后并发症。术前有吸烟或放疗史的患者应慎重考虑做腹部皮瓣乳房重建，而年龄、肥胖等因素不应成为腹部皮瓣乳房重建的禁忌。Objective To study the postoperative complications and its risk factors in patients underwent breast reconstruction with abdominal flaps. Methods The clinical data of 115 cases underwent breast reconstructions with abdominal flaps from May 2001 to October 2008 was reviewed. The postoperative complications included total flap necrosis, partial flap necrosis, fat necrosis, hernia, bulge, fat liquefaction and infection. The risk factors of complication rates were also evaluated. Results The total postoperative complications rate was 17.4% （20/115）. No severe complications was found, such as total flap necrosis, hernia and bulge. The most common complications of flap was fat necrosis which occurred in 6 cases （5.2%）, partial flap necrosis in 5 cases （4.3%） and infection in 1 case（0.9%）. The donor-site complications included fat liquefaction which occurred in 8 cases（7. 0% ） and infection in 3 cases（2. 6% ）. No significant relation was found between patient＇s age, body mass index （BMI） , timing of surgery and the postoperative complication rate. The postoperative complications occurred more frequently in active smokers, patients with radiotherapy history, or reconstructions with pedicled transverse rectus abdominis myocutaneous （TRAM） flaps. But no significant difference was found in those factors. Conclusions Fewer complications happens in patients with a reconstruction with deep inferior epigastric perforator（DIEP） flap. Abdominal flap should be performed with more consideration in active smokers or patients with a radiotherapy history. Age and obesity should not be contraindications to breast reconstruction with abdominal flaps.

关 键 词：乳腺肿瘤 乳房成形术 皮瓣 并发症 

分 类 号：R686[医药卫生—骨科学]