保留肋骨的胸廓内血管显露及吻合技术在腹壁下动脉穿支皮瓣重建乳房中的应用  

RIB-SPARING TECHNIQUE FOR INTERNAL MAMMARY VESSELS EXPOSURE AND ANASTOMOSIS IN BREAST RECONSTRUCTION WITH DEEP INFERIOR EPIGASTRIC PERFORATOR FLAP

作　　者：曾昂[1] 朱琳[1] 刘志飞[1] 王晓军[1] 张海林[1] 白明[1] 王智[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院整形外科,北京100730

出　　处：《中国修复重建外科杂志》2014年第11期1376-1379,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨在腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣移植乳房重建或修复胸壁缺损时,采用保留肋骨的胸廓内血管显露及吻合技术改善受区畸形的效果。方法 2009年11月-2011年9月,收治11例乳癌术后女性患者。年龄33~65岁,平均42岁。其中10例行DIEP皮瓣移植二期乳房重建术;1例因放疗后胸壁慢性溃疡,采用DIEP皮瓣移植修复胸壁缺损。皮瓣切取范围18 cm×9 cm^28 cm×12 cm。术中分离胸廓内血管时,采用保留肋骨的血管分离技术,并将胸廓内动、静脉和腹壁下动、静脉端端吻合。腹壁供区均直接缝合。结果 11例患者均成功应用保留肋骨的胸廓内血管显露及吻合技术。血管显露操作时间38~65 min,平均52 min;显露的胸廓内血管长度为1.3~2.2 cm,平均1.7 cm。术后DIEP皮瓣均成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合。患者均获随访,随访时间8~26个月,平均12个月。10例乳房重建患者外形满意,1例胸壁修复患者溃疡无复发。无1例出现胸壁术区疼痛不适,无胸壁凹陷畸形发生。结论 DIEP皮瓣移植乳房重建或修复胸壁缺损术中,采用保留肋骨的胸廓内血管显露及吻合技术安全、有效,能减少受区胸壁凹陷畸形的发生。Objective To explore the feasibility and reliability of rib-sparing technique for internal mammary vessels exposure and anastomosis in breast reconstruction and thoracic wall repair with deep inferior epigastric perforator （DIEP） flaps. Methods Between November 2009 and September 2011, 11 female patients with post-mastectomy deformities were treated. The mean age was 42 years （range, 33-65 years）. Of them, 10 patients underwent breast reconstruction with the DIEP flaps, and 1 patient received defect repair for chronic thoracic wall irradiated ulcer with the DIEP flap. The size of the flap ranged from 18 cm × 9 cm to 28 cm × 12 cm. Rib-sparing technique was applied in all these cases. The internal mammary vessels were exposed by dissection intercostal space and anastomosed with the deep inferior epigastric vessels. The donor sites were closed directly in all cases. Results In all cases, the rib-sparing technique for internal mammary vessels exposure and anastomosis was successfully performed. The mean time for internal mammary vessels exposure was 52 minutes （range, 38-65 minutes）. The mean exposure length of the internal mammary vessels was 1.7 cm （range, 1.3-2.2 cm）. All flaps survived completely postoperatively, and wounds and incisions at donor sites healed primarily. All patients were followed up 8-26 months （mean, 12 months）. All patients were satisfied with the reconstructive outcomes. No collapse deformity or discomfort of the thoracic wall occurred. Conclusion The rib-sparing technique for internal mammary vessels exposure and anastomosis is a reliable and reproducible approach to reconstruct the breast and repair the thoracic wall with DIEP flap, and it can reduce collapse deformity of the thoracic wall.

关 键 词：胸廓内血管显露及吻合技术 腹壁下动脉穿支皮瓣 乳房重建 

分 类 号：R655.8[医药卫生—外科学]