51例乳腺癌患者术后游离腹壁皮瓣乳房重建的临床分析  

A retrospective study of 51 cases with abdominal based free flap breast reconstruction after mastectomy for breast cancer

作　　者：陈嘉莹[1] 陈嘉健[1] 曹阿勇[1] 薛静彦[1] 陈灿铭[1] 柳光宇[1] 胡震[1] 狄根红[1] 韩企夏[1] 沈镇宙[1] 邵志敏[1] YU Pei-rong 吴炅[1] 

机构地区：[1]复旦大学附属肿瘤医院乳腺外科,复旦大学上海医学院肿瘤学系,上海200032 [2]M．D．Anderson癌症中心整形外科,德克萨斯州休斯顿

出　　处：《中国癌症杂志》2012年第5期367-372,共6页China Oncology

摘　　要：背景与目的:随着乳腺癌患者预后的不断改善,全乳切除后接受乳房重建手术的患者比例正逐年增高。腹部游离皮瓣是目前应用最多的自体组织乳房重建方法。本研究旨在探讨游离腹壁皮瓣乳房重建在临床实践中的应用价值。方法:对2006年6月—2011年11月在复旦大学附属肿瘤医院接受游离腹壁皮瓣乳房重建的51例乳腺癌患者进行回顾性分析。在51例患者(1例患者为双乳重建,手术计52例次)中,行游离的横行腹直肌(free transverse rectus abdominis myocutaneous,F-TRAM)手术1例次,保留肌肉的F-TRAM19例次,DIEP 32例次。结果:手术成功49例(96.1%)。受区血管的选择:胸廓内血管42例次(80.8%);胸外侧血管1例次(1.9%);肩胛下血管9例次(17.3%)。穿支平均数量为2.31支(1～4支),平均手术时间为8.1 h(4.6～12 h),平均住院时间为20 d(10～39 d),术后平均住院时间为11 d(4～22 d)。在Ⅰ期重建的40例患者中(包括1例双侧Ⅰ期乳房重建),术后化疗有23例(57.5%),其手术距离首次化疗时间为15.6 d(7～33 d)。乳房重建术后乳头重建患者13例(25.5%)。随访1.2～38.5个月,中位随访7.5个月。全部皮瓣坏死2例(3.92%),皮瓣感染1例(1.96%),皮瓣下血肿1例(1.96%),部分脂肪坏死8例(15.69%),腹部并发症3例(5.88%)。患者总体满意度为8.5分。结论:游离腹壁乳房重建有较好的临床应用价值。血供佳,皮瓣组织量大,可以满足大部分患者的需求。术后供区并发症较少,患者对重建形体的满意度较高。但该术式需要较高的手术技巧、先进的手术设备及护理团队的配合。Background and purpose： With the improvement of the prognosis of breast cancer, there has been a dramatic increase in the incidence of breast reconstruction after mastectomy over the past few years. Abdominal based free flaps have become the most commonly used flap reconstruction. This study aimed to evaluate the clinical utility of abdominal based free flap breast reconstruction after mastectomy for breast cancer. Methods： A review of 52 abdominal based free flap breast reconstructions （51 patients） from Jun. 2006 to Nov. 2011 was undertaken, comprising 1 free transverse rectus abdomenis myocutaneous （F-TRAM） flap, 32 deep inferior epigastric artery perforator （DIEP） flaps and 19 muscle sparing F-TRAM flaps. The follow-up data were assessed. Results： Forty-nine among 51 patients were successfully received the abdominal based free flap breast reconstruction. The overall success rate was 96.1%. Four patients had further procedures for either vessels re-anastomosis or flap excisions. Internal thoracic vessels were used as recipient vessels in 42 flaps （80.1%） while subscapular vessels in 9 flaps （17.3%） and lateral thoracic vessels in 1 flap （1.9%）. The mean number of perforator vessel was 2.31, ranging from 1 to 4. Mean duration of hospitalization was 20 days, ranging from 10 to 39 days. Mean post-operation duration of hospitalization was l 1 days, ranging from 4 to 22 days. Twenty-three patients （57.5%） received chemotherapy after immediate breast reconstruction. Time of the first chemotherapy was 15.6 days after operations. Thirteen patients （25.5%） had nipple reconstruction after breast reconstruction. Median follow-up time was 7.5 months, ranging from 1.2 to 38,5 months. Two patients （3.92%） had total flap loss, 1 （1.96%） had flap infection, 1 （1.96%） had hematoma, 8 （15.69） had partial fat necrosis, 3 （5.88%） had abdominal wall complications. The overall aesthetic satisfaction was 8.5. Conclusion： The abdominal based free flap reconstruction can be u

关 键 词：乳腺肿瘤 游离皮瓣 乳房重建 

分 类 号：R737.9[医药卫生—肿瘤]