胸背动脉穿支皮瓣在乳腺癌保乳手术一期乳房部分重建中的应用  

Pedicled thoracodorsal artery perforator flap in immediate partial breast reconstruction during breast conserving surgery for breast carcinoma

作　　者：陈天文 吴炅[2] 狄根红[2] 韩企夏[2] 沈镇宙[2] 邵志敏[2] 

机构地区：[1]广东省深圳市南山医院甲乳外科,518052 [2]复旦大学附属肿瘤医院

出　　处：《中华普通外科杂志》2011年第12期985-988,共4页Chinese Journal of General Surgery

摘　　要：目的 评价保乳手术联合应用带蒂胸背动脉穿支（thoracodorsal artery perforator,TDAP）皮瓣行一期乳房部分重建（immediate partial breast reconstruction,IPBR）的皮瓣设计、手术结果、重建乳房外观以及供皮区并发症情况.方法 回顾性分析复旦大学附属肿瘤医院乳腺外科2004年11月-2010年11月13例应用带蒂TDAP皮瓣行BCS＋ IPBR手术的乳腺癌患者随访资料.结果 胸背动脉主要穿支的位置位于腋后线、腋皱襞下7.5～9.5 cm（中位距离8.0 cm）,穿支术前多普勒超声体表定位与术中解剖的位置符合率为100％.单纯解剖穿支1例,余12例均在穿支周围保留1.0～3.0cm宽度的部分背阔肌.术后随访4～71个月,中位随访时间41个月.所有皮瓣均存活,供区均无血清肿及背阔肌功能障碍.重建乳房的外观以患者自我评价及门诊随访医生评价相结合的方式进行评估,结果9例为优良,3例为一般,1例为差.结论 TDAP皮瓣能满足乳腺癌保乳术后任何象限的局部缺损修复和重建,特别对于肿块局部切除活检后保乳的患者来说,能很好的重塑乳房外形,患者满意度较高.术前应用手持式多普勒超声对胸背动脉的主要穿支进行体表定位,有助于术中快速找寻及解剖穿支,减少血管损伤及血管危象的发生.Objective To discuss the design of pedicled thoracodorsal artery perforator flap （TDAP flap）,and to evaluate the aesthetic results and donor-site complications for immediate partial breast reconstruction （IPBR） after breast conserving surgery （BCS） for breast cancer patients.Method Clinical data of 13 breast cancer cases treated with BCS ＋ IPBR using TDAP flap from November 2004 to November 2010 were retrospectively analyzed.Perforators were identified with Doppler preoperatively in all patients.Results All perforators originated within a median distance of 8.0 cm （ range,7.5 to 9.5 cm） from axillary plica at the posterior line of axilla.Median area of the flaps was 6.0 × 8.0 cm （ range,5.0 × 7.0 cm to 8.0 × 10.0 cm）.One flap was muscle-sparing,while a small muscle strip was left embedding the perforators in other twelve flaps to increase the reliability of the vascular pedicle.Postoperatively patients were followedup from 4 to 71 months.Median follow-up time was 41 months.Flap necrosis and seroma in the donor-site were not found in all patients.Aesthetic results were graded as excellent or good in 9 patients,fair in 3,and poor in one.Conclusions TDAP flap is a good choice for IPBR after BCS for breast cancer patients whether lesions in outer quadrants or inner quadrants,especially for those patients with excisional biopsy.Preoperative mini-Doppler is helpful for determining the precise location of the main perforators,and decreasing the risk of vessels injury.

关 键 词：乳腺肿瘤 乳房成形术 外科皮瓣 

分 类 号：R737.9[医药卫生—肿瘤]