腹壁浅动静脉在下腹部皮瓣移植乳房再造中的应用  

Application of superficial epigastric artery and vein in breast reconstruction with lower abdominal flap transplantation

作　　者：宋达疆[1] 李赞[1] 章一新[2] Song Dajiang;Li Zan;Zhang Yixin(Department of Oncology Plastic Surgery,Hunan 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)

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200011

出　　处：《中华解剖与临床杂志》2022年第7期480-485,共6页Chinese Journal of Anatomy and Clinics

基　　金：湖南省自然科学基金(2018JJ2241、2018JJ2242);湖南省科技计划项目(2014SK3002);湖南省卫计委课题项目(B2014-111);湖南省肿瘤整形外科临床医学研究中心平台建设专项资助(2013TP4087)。

摘　　要：目的探讨腹壁浅动静脉在下腹部皮瓣移植乳房再造术中的应用占比情况及其作用。方法回顾性研究。纳入2015年11月—2018年12月湖南省肿瘤医院168例采用下腹部皮瓣移植的乳腺癌术后乳房再造患者的临床资料。患者年龄31~62(42.5±5.3)岁,体质量指数为23~32(27±1.8)kg/m^(2);均为单侧乳房再造,左侧102例、右侧66例。其中,一期乳房再造89例,二期乳房再造79例。观察项目:(1)分析腹壁浅动静脉在下腹部皮瓣移植乳房再造手术中应用的长度、管径、占比等情况;(2)术后随访观察皮瓣成活及再造乳房恢复情况。结果(1)168例患者中,89例(53.0%)患者的供区皮瓣同时携带腹壁浅静脉,(一期47例,二期42例),长度(4.20±0.27)cm、管径(1.30±0.25)mm,35例(20.8%)同时携带腹壁浅动静脉(一期16例,二期19例),长度(3.10±0.38)cm、管径(0.50±0.14)mm。实际移植2/4下腹部皮瓣74例(44.0%),全部采用一侧腹壁下动脉穿支皮瓣移植(一期55例,二期19例);实际移植3/4下腹部皮瓣54例(32.2%),一期22例,二期32例;实际移植4/4下腹部皮瓣40例(23.8%),一期12例,二期28例;(2)168例患者均获随访,随访12~42个月,皮瓣均成活顺利(成活率100%),再造乳房外形可,弹性好,无皮瓣挛缩变形,患者对外形较满意,腹部供区仅遗留线性瘢痕,腹部功能无明显受限。结论腹壁浅动静脉在下腹部皮瓣移植乳房再造术中的实际应用相对较少,是否携带腹壁浅动静脉不影响下腹部皮瓣移植的成活率。Objective To summarize the application and role of superficial epigastric artery and vein in breast reconstruction with lower abdominal flap transplantation.Methods From November 2015 to December 2018,168 breast cancer patients in Hunan Cancer Hospital received breast reconstruction with different forms of abdominal skin flap transplantation.Among them,the age ranged from 31 to 62(42.5±5.3)years,and the body mass index ranged from 23 to 32(27±1.8).All cases were unilateral breast reconstruction,including 102 cases on the left and 66 cases on the right.Eighty-nine were one-staged breast reconstruction and 79 were two-staged breast reconstruction.Observation items:(1)the application proportion of superficial epigastric artery and vein in breast reconstruction with lower abdominal flap transplantation was analyzed;(2)the survival of flap and the recovery of reconstructed breast were observed after operation.Results(1)There were 89 cases(53.0%)with superficial epigastric vein(47 cases in one-staged and 42 cases in two-staged),the length was(4.20±0.27)cm,the diameter was(1.30±0.25)mm;and 35 cases(20.8%)with superficial epigastric artery and vein(16 cases in one-staged and 19 cases in two-staged),the length was(3.10±0.38)cm,the diameter was(0.50±0.14)mm;74 cases(44.0%)were actually transplanted with 2/4 lower abdominal flap(55 cases in one-staged and 19 cases in two-staged);54 cases(32.1%)were actually transplanted with 3/4 lower abdominal flap;40 cases(23.8%)were actually transplanted with 4/4 lower abdominal flap(12 cases in s one-staged and 28 cases in two-staged).(2)All patients were followed up for 12-42 months(average 23.5 months).All flaps survived smoothly,the reconstructed breast shape and elasticity was good,and there was no flap contracture and deformation.Conclusion Superficial inferior epigastric artery and vein are rarely used in breast reconstruction with lower abdominal flap transplantation.

关 键 词：腹壁动脉 腹壁浅动脉 腹壁浅静脉 腹壁下动脉穿支皮瓣 乳房再造术 

分 类 号：R655.8[医药卫生—外科学]