带蒂股薄肌肌皮瓣在会阴缺损修复中的延展解剖研究  

Extending anatomical basis of pedicled gracilis musculocutaneous flaps in perineal reconstruction

作　　者：王黎[1] 宋达疆[2] 李赞[2] 张克强[3] 章一新[4] 彭小伟[2] 冯光[5] 周波[2] 吕春柳[2] 伍鹏 唐园园 易亮 罗振华 Wang Li;Song Dajiang;Li Zan;Zhang Keqiang;Zhang Yixin;Peng Xiaowei;Feng Guang;Zhou Bo;Lyu Chunliu;Wu Peng;Tang Yuanyuan;Yi Liang;Luo Zhenhua(Department of Gynecology and Obstetrics,the First People’s Hospital of Changde,Changde 415000,China;Department of Oncology Plastic Surgery,Hunan Province Cancer Hospital,Changsha 410008,China;Fifth Department of Gynecological Oncology,Hunan Province Cancer Hospital,Changsha 410008,China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Burn and Plastic Reconstructive Surgery,Fourth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]常德市第一人民医院妇产科,415000 [2]湖南省肿瘤医院肿瘤整形外科,长沙410008 [3]湖南省肿瘤医院妇科肿瘤五科,长沙410008 [4]上海交通大学医学院附属第九人民医院整形外科,200011 [5]解放军总医院第四医学中心烧伤整形外科,北京100048

出　　处：《中华整形外科杂志》2020年第12期1375-1379,共5页Chinese Journal of Plastic Surgery

基　　金：湖南省自然科学基金面上项目(2018JJ2241,2018JJ2242);湖南省肿瘤整形外科临床医学研究中心平台建设专项(2013TP4087);湖南省科卫联合项目(2018JJ6028);湖南省卫健委课题(B2019092);长沙市科技计划基础研究项目(kq1901074,kq1901077)。

摘　　要：目的探讨带蒂股薄肌肌皮瓣在会阴肿瘤术后缺损修复中的延展设计解剖基础。方法选择6具新鲜成年女性尸体,年龄为27~52岁,平均41.2岁,解剖观察双侧股深动脉及进入股薄肌的肌支走行,测量血管蒂长度。模拟完成股薄肌肌皮瓣切取手术,先按照标准方式进行转移,随后再通过长收肌下隧道进行转移,进行延展设计。分别测量2种转移方式下12块肌皮瓣远端到双侧髂前上棘的距离。采用配对样本t检验(双尾)对2种转移方法测量的数据进行比较。结果经解剖发现6具尸体双侧股深动脉肌支全部走行于长收肌和大收肌之间,12块股薄肌肌皮瓣平均穿支血管蒂长度为(7.84±0.71)cm。标准方式转移后股薄肌肌皮瓣远端到同侧髂前上棘的距离为(9.23±0.95)cm(6.9~10.5 cm),到对侧髂前上棘的距离为(11.45±2.27)cm(7.5~14.8 cm)。通过长收肌下隧道转移延展设计后,皮瓣远端到同侧髂前上棘的距离为(4.52±1.18)cm(2.7~6.5 cm),到对侧髂前上棘的距离为(8.92±1.82)cm,(4.8~11.7 cm)。与标准方法相比,股薄肌肌皮瓣通过长收肌下隧道转移后,血管蒂同侧转移增加长度(4.71±1.14)cm(3.5~7.3 cm),平均4.71 cm;对侧转移增加长度(2.53±0.89)cm(0.9~4.1 cm)。2种方法测量的到同侧髂前上棘的距离比较,t=13.194,P<0.001;到对侧髂前上棘的距离比较,t=9.057,P<0.001,差异均具有统计学意义。通过长收肌下隧道转移双侧增加的可修复距离长度平均为3.62 cm,能提供的额外增加距离为平均血管蒂长度的46.2%(3.62/7.84)。结论尸体解剖结果显示,对股薄肌肌皮瓣进行延展设计可以增加血管蒂长度,扩大了其修复会阴的范围。Objective To explore the extending design and anatomical basis of pedicled gracilis musculocutaneous flaps in perineal reconstruction.Methods On six female cadavers(age ranged from 27 to 52 years old,41.2 on average),bilateral gracilis flaps were designed,raised and transferred in the standard surgical manner and tunneled under the adductor longus muscle.Measured the distance from the tip of 12 flaps to the bilateral anterior superior iliac spine(ASIS).The myocutaneous flaps were then transferred and the distances from the tip of flaps to the ASIS were measured again.The paired sample t test(double tail)was used to compare the data measured by the two transfer method.Results Cadaveric dissection revealed that in 6 corpses,bilateral profunda artery muscular branches all courses between the longus adductor and mangus adductor muscles,the pedicle length of 12 gracilis musculocutaneous flaps was(7.84±0.71)cm.In the standard surgical manner group,after transferring,the distance from the tip of flaps to the ipsilateral ASIS was(9.23±0.95)cm,ranged from 6.9 cm to 10.5 cm,the distance from the tip of flaps to the contralateral ASIS was(11.45±2.27)cm,ranged from 7.5 cm to 14.8 cm.In the tunnelled under the adductor longus muscle extension design group,after transferring,the distance from the tip of flaps to the ipsilateral ASIS was(4.52±1.18)cm,ranged from 2.7 cm to 6.5 cm,the distance from the tip of flaps to the contralateral ASIS was(8.92±1.82)cm,ranged from 4.8 cm to 11.7 cm.Compared with the standard surgical manner group,tunneling the flap under the adductor longus muscle to the ipsilateral side increased the reach by 3.5 cm to 7.3 cm,(4.71±1.14)cm,to contralateral side increased the reach by 0.9 cm to 4.1 cm,(2.53±0.89)cm.The distance to the ipsilateral anterior superior iliac spine measured by the two method,t=13.194,P<0.001,and the distance to the contralateral anterior superior iliac spine,t=9.057,P<0.001.The difference was statistically significant.The tunneled under the adductor longus muscle extension

关 键 词：肌皮瓣 外阴肿瘤 会阴 修复外科手术 股薄肌肌皮瓣 

分 类 号：R737.35[医药卫生—肿瘤]