腹直肌肌皮瓣在复发性外阴癌根治术后外阴形态重建中的应用  

Application of rectus abdominis myocutaneous flap in reconstruction of vulvar form after radical vulvectomy for recurrent vulvar carcinoma

作　　者：李峰永[1] 李强[1] 周传德[1] 周宇[1] 丁健[1] 曹玉娇[1] 张思娅[1] 魏蜀一[1] 

机构地区：[1]中国医学科学院北京协和医学院整形外科医院整形十科,北京100144

出　　处：《中国美容整形外科杂志》2013年第9期517-519,共3页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨应用腹直肌肌皮瓣在复发性外阴癌根治术后外阴形态重建术的方法及效果。方法自2009年2月至2013年5月，对6例复发性外阴癌的患者均采用广泛的外阴癌根治术，切除所有受累的外阴皮肤以及部分尿道、阴道、肛门、直肠。根据切除后外阴组织缺损面积的大小，在腹壁游离相应大小的腹直肌肌皮瓣，包含皮肤、肌肉、神经和血管，经阴阜区皮下隧道转移至外阴，将肌皮瓣覆盖于外阴软组织缺损区，重建外阴形态。结果6例患者获取腹直肌肌皮瓣为7em×10cm～14cm×18cm，会阴重建平均手术时间为3．5h（3．0～5．0h）。术后腹直肌肌皮瓣全部成活，随访2～6个月，重建外阴形态良好，尿道、阴道口无明显狭窄。其中，1例患者因自觉皮瓣臃肿，影响行走，于术后6个月时行脂肪抽吸术，形态改善。结论采用腹直肌肌皮瓣修复复发性外阴癌广泛切除术后的外阴创面，其皮瓣血运丰富，成活率高，术后外阴形态较满意。Objective To evaluate the effect of rectus abdominis myocutaneous flap on the reconstruc- tion of vulva form after radical vulveetomy for recurrent vulvar carcinoma. Methods Six patients underwent radical vulvectomy even including partial urethral, vagina, anus and rectum from February 2009 to May 2013. According to the size of the skin defect, a suitable size of rectus abdominis myocutaneous flap was harvested, which contained skin, subcutaneous fat, muscle, nutrient vessels and nerves. The flap was transferred to cover the defect of the vulvar tissue through a subcutaneous tunnel. Results Operation was uneventful for the 6 patients, the taken flaps ranged from 7 cm × 10 cm to 14 cm ×18 cm. The mean operative duration of reconstruction was 3.5 h （3.0 -5.0 h）. The transferred flaps survived completely in the 6 cases. The postoperative follow-up was performed for 2 to 6 months, and all cases were satisfied with the good contour and without stenosis of the urethra and the vigina except for one patient with hard walking because of the swelled flap which was improved by liposuction. Conclusion It is an effective method to use rectus abdominis myocutaneous flap to repair the secondary skin defect caused by radical vulveetomy for recurrent vulvar carcinoma. This flap has several advantages including good blood circulation and high survival rate. The technique improved the life quality of the patients with satisfying cosmetic outcomes.

关 键 词：腹直肌肌皮瓣 外阴癌 外阴癌根治术 外阴重建 

分 类 号：R737.350[医药卫生—肿瘤]