保留部分腹直肌TRAM皮瓣的应用解剖及在乳房再造中的应用  

Anatomic study and application of TRAM flap with partial preservation of abdominal rectus muscle in the breast reconstruction

作　　者：陈祥锦[1] 王彪[2] 郑厚兵[2] 张惠灏[1] 王美水[2] 张德杰[1] 庄福连[2] 

机构地区：[1]福建医科大学附属第一医院乳腺外科,福州350005 [2]福建医科大学附属第一医院整形外科,福州350005

出　　处：《中华整形外科杂志》2012年第4期248-252,共5页Chinese Journal of Plastic Surgery

基　　金：福建医科大学教授学术发展基金（JS10011）

摘　　要：目的通过尸体解剖模拟保留部分腹直肌的横行腹直肌肌皮瓣（TRAM）手术，以探讨将其应用于临床乳房再造的可行性及效果。方法对5具成年女性尸体标本（福建医科大学人体解剖学教研室提供），自腹壁上、下动脉起点处灌注医用红色乳胶后进行解剖，模拟操作保留部分腹直肌TRAM皮瓣手术，以外侧穿支为垂直线纵向分离腹直肌肌束，向上分离达腹直肌上端，保留外侧部分腹直肌，观察腹壁上、下动脉走行、分支以及吻合支情况，并以此为解剖学基础，于临床应用保留部分腹直肌的TRAM皮瓣进行乳房再造。结果解剖结果表明，腹壁下动脉自腹股沟韧带外侧2／3与内侧1／3发自髂外动脉（9／10，90％）或股动脉（1／10，10％），其分支与腹壁上动脉在脐上方开始出现广泛的吻合，大部分集中于脐上第1个腱划下方2cm与脐水平线之间。2009年9月至2010年9月，于临床应用8例，术后随访3个月至1年，2例术后皮瓣Ⅳ区部分皮下组织纤维化，2例术后皮瓣Ⅳ区皮缘小部分坏死，部分皮下脂肪硬结伴液化，通过后期清创缝合后愈合，其余4例术后皮瓣未发生明显血运障碍等并发症。除1例再造乳房形态欠佳外，其余病例形态尚好，效果较满意。无供区下腹壁薄弱和腹壁疝形成。结论保留部分腹直肌的TRAM皮瓣移植再造乳房是可行的，手术简单，所用时间短，且无下腹部供区并发症发生。[Abstract] Objective To investigate the feasibility and effectiveness of transverse rectus abdominis musculocntaneous （TRAM） flap with partial preservation of abdominal rectus muscle based on the anatomic study in cadavers. Methods 5 adult female cadavers which provided by department of anatomy of Fujian Medical University were dissected after injection with medical red latex from the starting point of the inferior epigastric artery and superior epigastric artery. The TRAM flap with partial preservation of lateral abdominal rectus muscle were dissected for breast reconstruction. The location, route, branches and anastomosis of inferior and superior epigastric arteries were observed. Based on the anatomic study, breast reconstruction were performed in 8 cases with muscle-sparing TRAM flaps. Results The inferior epigastric artery arises from external iliac artery （9/10, 90% ） or femoral artery（ 1/10, 10% ） at the joint point between the internal third and lateral two third. There are extensive anastomoses between superior and inferior epigastric arteries above the umbilicus, mostly between the 2cm below the first tendinous intersection and umbilical level. From Sept. 2009 to Sept. 2010, 8 cases received breast reconstruction with muscle-sparing TRAM flap. The patients were followed up for 3 months to one year. Fibrosis happenedin subcutaneous fat al flap Ⅳ zone in 2 cases, borderline necrosis and subeutaneous fat liquefaction occurred in some areas of flap Ⅳ zone in 2 eases, which healed after debridement. The other 4 cases healed with no complication. Except for unsatisfied shape in one case, good i＇esuh achieved in 7 eases. There was no abdominal weakness, hernia or other complication. Conclusions h is an effective and safe method in breast reconslruction with muscle-sparing TRAM flap. It is practical with comparatively short operalion time and less morbidity in donor site.

关 键 词：乳房再造术 横行腹直肌肌皮瓣 解剖学 局部 

分 类 号：R655.8[医药卫生—外科学]