游离腹壁下动静脉穿支皮瓣在乳腺癌术后一期乳房重建中的应用  

Application of Free Deep Inferior Epigastric Perforator Flap in Primary Breast Reconstruction After Breast Cancer Surgery

作　　者：林建华 吴千富 温济斌 李兰新 刘雪莹 LIN Jian-hua;WU Qian-fu;WEN Ji-bin;LI Lan-xin;LIU Xue-ying(Department of General Surgery,Guiping People's Hospital,Guiping 537200,Guangxi,China;Department of Hospital Infection Control,Guiping People's Hospital,Guiping 537200,Guangxi,China)

机构地区：[1]桂平市人民医院普通外科,广西桂平537200 [2]桂平市人民医院医院感染管理科,广西桂平537200

出　　处：《医学信息》2022年第13期152-155,共4页Journal of Medical Information

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(编号:Z20201171)。

摘　　要：目的研究游离腹壁下动静脉穿支皮瓣(DIEP)在乳腺癌术后一期乳房重建中的应用价值。方法选取2020年7月-2021年7月于桂平市人民医院行乳腺癌改良根治术的80例乳腺浸润性导管癌患者,按照随机数字表法分为对照组与观察组,各40例。两组均进行一期乳房重建,对照组采用横行腹直肌肌皮瓣(TRAM)重建方案,观察组则采用DIEP重建方案。比较两组围术期指标(术中出血量、术后24 h引流量、术后疼痛度、住院时间)、皮瓣成活率、腹壁疝发生率、术后并发症、外形满意度[乳腺癌患者报告结局量表(BREAST-Q)评分]、躯体活动舒适度[Kolcaba的舒适状况量表(GCQ)评分]、心理满意度(bradburn的情感量表评分)、社会适应能力[社会功能量表(SFRS)评分]。结果两组术中出血量、皮瓣成活率比较,差异无统计学意义(P>0.05);观察组术后24h引流量、术后疼痛度、住院时间均小于对照组,腹壁疝及术后并发症发生率低于对照组(P<0.05);观察组BREAST-Q评分、GCQ评分、情感量表评分高于对照组,SFRS评分低于对照组(P<0.05)。结论相较于传统乳房重建,DIEP重建手术疼痛小、术后恢复快,且可降低腹壁疝及术后并发症的发生风险,改善患者的躯体活动舒适度,同时提升其满意度及社会适应性。Objective To study the application value of free deep inferior epigastric perforator(DIEP)flap in primary breast reconstruction after breast cancer surgery.Methods A total of 80 patients with breast invasive ductal carcinoma who underwent modified radical mastectomy in Guiping People’s Hospital from July 2020 to July 2021 were randomly divided into control group and observation group,with 40 cases in each group.One-stage breast reconstruction was performed in both groups.The control group was treated with transverse rectus abdominis myocutaneous flap(TRAM)reconstruction scheme,and the observation group was treated with DIEP reconstruction scheme.The perioperative indexes(intraoperative blood loss,drainage volume24 h after operation,postoperative pain degree and hospitalization time),flap survival rate,incidence of abdominal hernia,postoperative complications,shape satisfaction[breast cancer patient report outcome scale(BREAST-Q)score],physical activity comfort[Kolcaba comfort status scale(GCQ)score],psychological satisfaction(bradburn emotional scale score)and social adaptation ability[social function scale(SFRS)score]were compared between the two groups.Results There was no significant difference in intraoperative blood loss and flap survival rate between the two groups(P>0.05).The 24 h drainage volume,postoperative pain and hospitalization time in the observation group were lower than those in the control group,and the incidence of abdominal wall hernia and postoperative complications in the observation group were lower than those in the control group(P<0.05).The BREAST-Q score,GCQ score and emotional scale score of the observation group were higher than those of the control group,and the SFRS score was lower than that of the control group(P<0.05).Conclusion Compared with traditional breast reconstruction,DIEP reconstruction has less pain,faster postoperative recovery,and can reduce the risk of abdominal wall hernia and postoperative complications,improve the physical activity comfort of patients,and improve

关 键 词：腺癌改良根治术 乳腺浸润性导管癌 乳房重建 腹壁下动静脉穿支皮瓣 横行腹直肌肌皮瓣 

分 类 号：R737[医药卫生—肿瘤]