大面积股内侧穿支皮瓣移植重建乳房的临床效果  

Clinical efficacy of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction

作　　者：宋达疆[1] 李赞[1] 周晓[1] 章一新[2] 彭小伟[1] 周波[1] 吕春柳[1] 伍鹏 唐园园 Song Dajiang;Li Zan;Zhou Xiao;Zhang Yixin;Peng Xiaowei;Zhou Bo;Lyu Chunliu;Wu Peng;Tang Yuanyuan(Department of Oncology and Plastic Surgery,Hunan Provincial Cancer Hospital,Changsha 410008,China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200000,China)

机构地区：[1]湖南省肿瘤医院肿瘤整形外科,长沙410008 [2]上海交通大学医学院附属第九人民医院整形外科,上海200000

出　　处：《中华医学美学美容杂志》2021年第1期29-33,共5页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：湖南省自然科学基金(2018JJ2241、2018JJ2242);湖南省科卫联合项目(2018JJ6028);湖南省卫健委课题(B2019092);湖南省肿瘤整形外科临床医学研究中心平台建设专项(2013TP4087)。

摘　　要：目的探讨以股薄肌皮瓣联合大收肌穿支皮瓣的股内侧皮瓣形式移植再造乳房的临床价值。方法2016年12月至2019年2月,湖南省肿瘤医院肿瘤整形外科收治16例女性乳腺癌患者,年龄27~59岁,平均40.3岁。肿瘤均为单侧,左侧9例,右侧7例;直径1.5~4.5(2.9±0.3)cm;全部为一期病例。病理诊断浸润性导管癌9例、浸润性小叶癌7例。完成乳腺癌改良根治术后采用股内侧穿支皮瓣移植再造乳房,患者分为A、B两组。在A组切取股薄肌皮瓣联合大收肌穿支皮瓣,在B组直接制备面积较大、宽度可达到股薄肌前缘前方的大收肌穿支皮瓣,用ICG荧光造影技术验证皮瓣血运后所有皮瓣仅通过一支大收肌穿支血管作为血管蒂。结果共切取移植8例股薄肌皮瓣联合大收肌穿支皮瓣和8例大收肌穿支皮瓣,皮瓣长(27.5±0.4)cm、宽(7.1±0.5)cm、厚(3.8±0.4)cm,股薄肌皮瓣血管蒂长度(7.4±0.3)cm,大收肌穿支皮瓣血管蒂长度(10.8±0.5)cm。皮瓣重量195~315 g,平均255 g;皮瓣缺血时间55~90 min,平均75 min。16例患者都选用胸廓内血管近远端作为受区吻合血管。仅吻合大收肌穿支血管就可保证皮瓣血运可靠,两组均未用血管吻合备选方案。所有皮瓣均一期成活,再造乳房外形弹性好,无明显皮瓣挛缩变形。16例平均随访12.5个月,患者自我感觉外形较满意。股内侧皮瓣供区仅遗留线性瘢痕,位置隐蔽,髋关节及腿部功能无影响。结论以大收肌穿支血管为蒂可安全可靠切取大面积股内侧穿支皮瓣,无需额外制备股薄肌血管蒂。Objective To explore the necessity of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction.Methods From December 2016 to February 2019,16 female breast cancer patients,aged 27-59 years,with an average of 40.3 years,were treated in the Department of Oncoplastic Surgery,Hunan Cancer Hospital.The tumors were unilateral in 9 cases on the left side and 7 cases on the right side,with a diameter of 1.5-4.5(2.9±0.3)cm,and all of them were stage I.Pathological diagnosis included 9 cases of invasive ductal carcinoma and 7 cases of invasive lobular carcinoma.After the modified radical mastectomy,the medial thigh perforator flap was used to reconstruct the breast.Patients were randomly divided into group A and group B.In group A,the gracilis myocutaneous flap combined with the adductor magnus perforator flap was elevated.In group B,the adductor magnus perforator flap with large size reaching the front edge of gracilis muscle was directly harvested.After all the flaps were harvested with only one major adductor perforator as vascular pedicle,ICG fluorescence imaging technology was used to verify the blood supply of the flaps.Results Eight cases of gracilis myocutaneous flap combined with adductor magnus perforator flap and 8 cases of adductor magnus perforator flap were transplanted,The length,width and thickness of the flaps were(27.5±0.4)cm,(7.1±0.5)cm and(3.8±0.4)cm,(7.4±0.3)cm and(10.8±0.5)cm respectively.The average weight of the flap was 255 g(195 g-315 g).The mean ischemia time was 75 min(55-90 min).In 16 cases,the proximal and distal ends of internal mammary vessels were used as the recipient vessels.Only anastomosing the adductor magnus perforator vessels could ensure the reliable blood supply of the flap.All flaps survived successfully in one stage.The appearance of reconstructed breast was good and there was no obvious flap contracture and deformation.16 cases were followed up for an average of 12.5 months,and the patients'self perception and appearance were sat

关 键 词：乳腺肿瘤 修复外科手术 股薄肌皮瓣 大收肌穿支皮瓣 乳房重建 

分 类 号：R655.8[医药卫生—外科学]