腋窝入路内镜辅助背阔肌切取技术在修复Poland综合征胸壁畸形中的应用  

Thoracic wall reconstruction in Poland syndrome: an endoscopic approach to transfer latissimus dorsi muscle flap with single transverse axillary incision

作　　者：欧阳熠烨 徐伯扬 陈琳 李尚善 付苏 辛敏强 栾杰 刘春军 Ouyang Yiye;Xu Boyang;Chen Lin;Li Shangshan;Fu Su;Xin Minqiang;Luan Jie;Liu Chunjun(Department of Aesthetic and Reconstructive Breast Surgery,Plastic Surgery Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100144,China)

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乳房整形美容中心,100144

出　　处：《中华整形外科杂志》2020年第11期1187-1193,共7页Chinese Journal of Plastic Surgery

基　　金：首都卫生发展科研专项基金(2016-2-4041);协和青年基金(3332015156)。

摘　　要：目的探讨通过腋窝横切口内镜辅助背阔肌切取技术应用于修复Poland综合征胸部畸形的安全性和有效性。方法2015年10月至2018年1月,在中国医学科学院整形外科医院乳房整形美容中心招募Poland综合征患者,采用经腋窝横切口内镜辅助背阔肌转移进行胸壁重建或乳房再造(联合乳房假体置入)。术后对背阔肌肌瓣成活情况、胸背部形态以及并发症情况进行随访,并统计以下数据:背阔肌肌瓣面积、假体体积、对侧乳房手术情况、背阔肌切取时间、前胸壁腔隙分离时间、手术总时间、引流时间。采用疼痛视觉模拟量表评估术后疼痛程度;采用Breast-Q量表重建模块评估女性患者心理社会幸福感、乳房满意度及所有患者对手术结果的满意度;采用上肢功能障碍量表(DASH量表)对患者手术前、后的上肢功能进行评估。采用配对t检验分析患者手术前、后的Breast-Q量表和DASH量表得分差异。结果共纳入28例患者,其中男11例,女17例,年龄(22.5±3.9)岁,体质量指数为(20.5±6.1)kg/m2,其中2例女性患者同时行对侧腋窝入路假体隆乳术,2例行对侧自体脂肪移植隆乳术。术后随访时间(50.4±23.1)个月,重建的乳房或胸壁形态良好,背阔肌肌瓣血供良好,均完全成活,患者术后疼痛轻微,无明显胸背部形态异常。术后并发症包括血清肿1例,切口裂开1例,皮瓣下移1例,无皮瓣坏死、血肿、假体相关并发症发生。背阔肌肌瓣面积为(437.2±110.0)cm2,再造乳房使用假体体积为(240.4±46.0)ml。内镜下切取背阔肌时间为(69.0±13.9)min,内镜下分离前胸壁腔隙时间为(32.8±6.0)min,手术总时间为(169.4±16.1)min,术后引流时间为(7.6±1.4)d。术后第1天患者疼痛视觉评分为(2.7±0.5)分,1周后评分下降至(0.8±0.4)分。手术前乳房满意度评分为(27.8±20.8)分,心理社会幸福感评分为(49.6±17.0)分,术后乳房满意度评分为(63.1±11.6)分,心理社会幸福�Objective The purpose of this study was to introduce an endoscopic approach to harvest latissimus dorsi muscle(LDM)flap using a single transverse axillary incision and evaluate its safety and efficacy to repair the chest deformities of Poland syndrome.Methods Poland syndrome patients were recruited prospectively to repair the thoracic wall deformity plus breast reconstruction(combined with breast implant insertion)using the endoscopic approach to transfer LDM flap with single transverse axillary incision in the Department of Aesthetic and Reconstructive Breast Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences,from October 2015 to January 2018.Information including patient demographics,LDM area,implant size,contralateral symmetry surgery,operative time(endoscopic time for LDM flap harvesting,endoscopic anterior subcutaneous pocket creating time and total time),the survival of LDM flap,deformity of thoracic wall and back and post-operative complications were collected.The pain visual analog scale was used to assess the severity of postoperative pain.The Breast-Q reconstruction module was used to evaluate patients’psychosocial well-being and satisfaction with the outcome.The disabilities of the arm,shoulder,and hand(DASH)outcome questionnaire was used to evaluate patient upper extremity disabilities.A paired t-test was utilized to analyze the difference between the preoperative and postoperative score of the Breast-Q and DASH questionnaire.Results Twenty-eight patients were recruited in this study,including 11 males and 17 females aged(22.5±3.9)years old with a body mass index of(20.5±6.1)kg/m2.Two patients received contralateral implant augmentation and two received fat grafting for breast symmetry.The postoperative follow-up time was(50.4±23.1)months.All the reconstructed breasts or thoracic walls was in a good shape.All the LDM flap survived with good blood supply.The postoperative pain was mild,and there was no obvious abnormality of the thoracic wall and back.The area of harvested LDM fl

关 键 词：POLAND综合征 内窥镜 背阔肌 乳房成形术 胸壁再造 

分 类 号：R655.8[医药卫生—外科学]