胸背动脉穿支组织瓣用于乳腺癌保留乳房手术联合一期部分乳房成形术33例临床分析  

Breast-conserving surgery with immediate partial breast reconstruction using pedicled thoracodorsal artery perforator flap：a clinical analysis of 33 patients

作　　者：汪星[1] 何英剑[1] 李金锋[1] 解云涛[1] 王天峰[1] 范照青[1] 霍苓[1] 欧阳涛[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所乳腺中心恶性肿瘤发病机制及转化研究教育部重点实验室,100143

出　　处：《中华外科杂志》2017年第2期120-125,共6页Chinese Journal of Surgery

摘　　要：目的：探讨胸背动脉穿支（ TDAP ）组织瓣在乳腺癌保留乳房手术联合一期部分乳房成形术中的应用价值。方法本研究为前瞻性病例系列研究。2013年6月至2016年3月按纳入和排除标准收集北京大学肿瘤医院乳腺中心因原发性乳腺癌拟行保留乳房手术联合一期TDAP组织瓣转移乳房成形术的患者资料。共入组128例，符合手术条件并成功完成手术者33例。患者均为女性，年龄22～52岁，中位年龄40岁。分析穿支血管定位、供区设计、术后并发症等资料，评价放化疗对手术效果的影响。结果术前多普勒超声探查胸背动脉穿支平均直径（1？5±0？4）mm，平均皮瓣大小15 cm＆#215;6 cm。手术时间120～245 min，平均手术时间（271±72） min，平均拔除引流管时间（4？7±2？1）d。患者均获得随访，中位随访时间17（12）个月[M（QR）]，无局部复发及远处转移。 TDAP组织瓣全部成活，术后切口并发症发生率为6％（2／33）。结论 TDAP组织瓣一期乳房成形术是修复乳腺癌保留乳房手术局部乳房缺损的良好选择。此术式不影响背阔肌功能，供区并发症较少。Objective To explore the application value of pedicled thoracodorsal artery perforator flap in immediate partial breast reconstruction for breast cancer.Methods This study is a prospective case series studies. Totally 128 cases of primary breast cancer patients who prepared to receive the breast.conserving surgery combine with immediate partial breast reconstruction of pedicled thoracodorsalartery perforator flap were enrolled in Breast Cancer Prevention and Treatment Center of Peking University Cancer Hospital from June 2013 to March 2016. Finally, the operations had been completed successfully in 33 eligible cases. All patients were female with a median age of 40 years （ ranging from 22 to 52 years）. The perforator vessel location, the donor area design, the post.operative complications, the influence of radiation and chemotherapy had been evaluated. Results The average diameter of thoracic dorsal artery perforators measured by Doppler ultrasound before the operation was （1.5±0.4） mm （ranging from 0.6 to 2.7 mm）. The average size of flaps was 15 cm＆#215;6 cm. The average time of operations was （271±72） minutes （ranging from 120 to 245 minutes）. Drainage tube removed on （4.7±2.1） days after operation （ranging from 3 to 12 days）. All patients received follow.up,and there was no local recurrence and distant metastasis during a median follow.up of 17（12） months （M（QR）） （ranging from 5 to 38 months）.All TDAP flaps were survival, the wound complication rates was 6% （ 2/33） . Conclusions The breast reconstruction of pedicled thoracodorsal artery perforator flap is a good choice of repairing local breast defect of breast conserving surgery.Its advantages are no-influence of latissimus dorsi function and little complications in donor area.

关 键 词：乳腺肿瘤 乳房成形术 外科皮瓣 胸背动脉 

分 类 号：R737.9[医药卫生—肿瘤]