游离腹壁下动脉穿支皮瓣移植在纵形瘢痕乳腺癌二期再造乳房塑形中的作用  

Effect of free deep inferior epigastric artery perforator flap transplantation in breast shaping of two-staged breast reconstruction with vertical scar

作　　者：宋达疆[1] 唐园园 李赞[1] 周晓[1] 章一新[2] 冯光[3] 周波[1] 吕春柳[1] 易亮 罗振华 王志远[4] SONG Dajiang;TANG Yuanyuan;LI Zan;ZHOU Xiao;ZHANG Yixin;FENG Guang;ZHOU Bo;LÜChunliu;YI Liang;LUO Zhenhua;WANG Zhiyuan(Department of Oncology Plastic Surgery,Hunan Cancer Hospital,Changsha Hunan,410008,P.R.China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200000,P.R.China;Department of Burn and Plastic Reconstructive Surgery,the Fourth Medical Center of Chinese PLA General Hospital,Beijing,100048,P.R.China;Ultrasound Diagnosis Center,Hunan Province Cancer Hospital,Changsha Hunan,410008,P.R.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 [3]解放军总医院第四医学中心烧伤整形外科,北京100048 [4]湖南省肿瘤医院超声诊断中心,长沙410008

出　　处：《中国修复重建外科杂志》2021年第10期1323-1327,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：湖南省卫健委课题项目(B2019092、20201650、20200829);长沙市科技计划基础研究项目(kq1901074、kq1901077);湖南省自然科学基金科卫联合项目(2018JJ6028、S2018SFYLJS0174);湖南省技术创新引导计划项目(2018SK50906)。

摘　　要：目的总结游离腹壁下动脉穿支皮瓣(deep inferior epigastric artery perforator flap,DIEP)移植在纵形瘢痕乳腺癌二期再造中乳房塑形的难点和要点。方法回顾分析2015年10月—2019年10月收治的32例二期行游离DIEP移植再造乳房的乳腺癌术后患者,原手术切口均为垂直纵形。患者均为女性;年龄31~42岁,平均34.6岁。乳腺癌病程9~48个月,平均22.8个月。均采用对侧血管蒂的游离DIEP移植,受区血管为胸廓内血管。其中17例皮瓣为纵形摆放,15例皮瓣为斜形摆放;18例采用辅助"Z"字皮瓣调整受区胸壁皮袋;23例同时行对侧乳房缩乳上提术。结果所有DIEP完全成活,供、受区创面均Ⅰ期愈合。1例病理检查发现内乳淋巴结转移,术后行放疗。32例均获随访,随访时间9~48个月,平均19.4个月。所有皮瓣外观、质地满意,供区仅遗留线性瘢痕。11例患者术后行自体脂肪移植和乳头重建。所有患者腹壁活动无影响,均未见局部复发和转移。结论在乳腺癌改良根治术后纵形瘢痕情况下,采用游离DIEP移植二期再造乳房难度较大,结合不同的乳房塑形技巧可以明显改善重建效果。Objective To summarize the difficulties and key points of free deep inferior epigastric artery perforator flap(DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar.Methods The clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months(mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them,17 flaps were placed longitudinally, 15 flaps were placed obliquely;Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases.Results All DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found. Conclusion It is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.

关 键 词：腹壁下动脉穿支皮瓣 皮瓣塑形 乳腺癌 乳房再造 

分 类 号：R737.9[医药卫生—肿瘤]