脱目镜三维可视技术在两例乳腺癌根治术后乳房缺损修复中的初步应用  

The preliminary application of 3-dimensional visual technique without eyepiece in repairing breast defect after radical mastectomy in 2 cases of breast cancer

作　　者：穆籣[1] 刘岩[1] 毕晔[1] 臧荟然 曹赛赛[1] 汤慧 朱怡[1] 陈玉杰 杨锴[1] 王偲[1] Mu Lan;Liu Yan;Bi Ye;Zang Huiran;Cao Saisai;Tang Hui;Zhu Yi;Chen Yujie;Yang Kai;Wang Cai(Plastic&Aesthetic Surgery Department,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院整形美容科,北京100044

出　　处：《中华显微外科杂志》2019年第5期434-437,共4页Chinese Journal of Microsurgery

基　　金：北京大学人民医院研究与发展基金(RDC2014-27)。

摘　　要：目的报道应用脱目镜三维可视技术(3D屏幕)显微吻合血管和淋巴管的可行性。方法2019年3月,对2例乳腺癌根治术和改良根治术后乳房缺损、胸壁畸形、腋窝瘢痕挛缩、上肢淋巴水肿患者(分别为48岁、62岁)行胸壁瘢痕切除松解、腋窝瘢痕切除松解、腹部皮瓣转移行乳房再造、胸壁畸形矫正、腋窝充填、静脉和淋巴管吻合术。术中应用脱目镜3D屏幕显微剥离穿支动、静脉并吻合血管和淋巴管;对2.5 mm静脉应用吻合器进行吻合(左侧腹壁下静脉与左胸背静脉远心端);对2.0 mm动脉(左腹壁下动脉与左胸背动脉远心端)以9-0线端端吻合。术中应用美蓝荧光行患侧上肢逆向淋巴显影,将腋窝彻底松解瘢痕后,将回流上肢的2条主要淋巴管断端(口径分别为0.2 mm及0.3 mm)与侧胸淋巴组织瓣中的静脉(口径0.5 mm)行端端吻合;吻合后,淋巴荧光示踪显示吻合通畅,观察术后疗效。已制定长期随访方案。结果术后2例患者恢复良好,皮瓣血运良好,再造乳房形态满意;患肢均感觉明显轻松,肿胀感减退,周径较术前减小约2.0 cm。结论脱目镜3D屏幕三维可视技术可用于血管和淋巴管的显微吻合,值得进一步应用,总结其优势。Objective To investigate the possibility of microsurgical anastomosis of artery,vein and lymphatic vessel under 3-dimension screen without eyepiece.Methods During March,2019,2 cases(48 and 62 years old)were operated for breast reconstruction,chest wall deformity modified,and axillary scar contracture release,under 3-dimension screen without eyepiece.Deep epigastric artery perforators(artery and vein)dissections were carried on,and microsurgical anastomosis of artery,vein and lymphatic vessel were finished.Coupler was used to do the end-to-end anastomosis of veins(2.5 mm),interrupted suture end-to-end anastomosis with 9-0 nylon for artery(2.0 mm).Reverse arm lymphatic dynamic fluorescence methylene blue tracer under Near Infrared Imaging was used to test the function of lymphatic system.The ends of 2 dominant drainage lymphatic vessels was found in the released axillary area(0.2 mm and 0.3 mm,respectively),and were anastomosis to the vein(0.5 mm)of lateral chest lymphatic tissue.Immediate methylene blue tracer under near infrared imaging was used to confirm the patency of lymphatic vessels-veins anastomosis and follow-up post operation.Flap were monitored use HHD.Results Two patients recovered well,and the flaps survived completely with appreciated appearances.The lymphedema of the arms were getting better,the peripheral diameter was reduced by about 2.0 cm compared with that before operation.Conclusion The technique of microsurgical anastomosis of artery,vein and lymphatic vessel without eyepiece under 3-dimension screen is possible and safe.

关 键 词：三维可视技术(3D屏幕) 脱目镜 乳房再造 淋巴水肿 血管显微吻合 淋巴管吻合 

分 类 号：R73[医药卫生—肿瘤]