吲哚菁绿荧光显影在乳房重建术中植入物选择的应用  

Application of indocyanine green angiography in the selection of implant for breast reconstruction

作　　者：屈翔[1] 王子函[2] 谢芳[3] 武珊珊[1] 杨小宝 高国璇 徐威 QU Xiang;WANG Zihan;XIE Fang;WU Shanshan;YANG Xiaobao;GAO Guoxuan;XU Wei(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,P.R.China;Department of Breast Disease,Peking University People’s Hospital,Beijing 100044,P.R.China;Department of Surgery,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,P.R.China)

机构地区：[1]首都医科大学附属北京友谊医院普外中心,北京100050 [2]北京大学人民医院乳腺中心,北京100044 [3]首都医科大学附属北京中医医院外科,北京100010

出　　处：《中国普外基础与临床杂志》2022年第11期1421-1426,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：首都卫生发展科研专项(项目编号:2020-2-1112);首都医科大学附属北京友谊医院启动课题(项目编号:yyqdkt2018-11)。

摘　　要：目的分析单孔腔镜乳房重建术中吲哚菁绿(indocyanine green,ICG)荧光显影对评估乳头乳晕复合体(nipple-areola complex,NAC)血运和植入物选择的价值。方法回顾性收集2018年11月至2020年3月期间首都医科大学附属北京友谊医院收治的19例行单孔充气法腔镜乳腺癌根治术联合乳房重建治疗的患者,该组患者应用ICG荧光显影技术,评估NAC的供血模式和缺血坏死风险,从而指导植入物选择;同时选择2017年2月至2018年10月期间于该医院行单孔充气法腔镜乳腺癌根治术联合乳房重建的14例患者作为历史对照(对照组)。比较2组患者的NAC缺血坏死、乳房满意度和植入物取出情况。结果ICG组患者中,V1模式3例,2例出现乳头NAC缺血坏死(1级1例,2级1例);V2模式和V3模式16例,均未出现NAC缺血坏死;所有患者未出现植入物丢失。对照组5例出现NAC缺血坏死(均属于严重缺血坏死),2例出现植入物丢失。ICG组的NAC严重缺血坏死率低于对照组(P<0.01),但2组的植入物丢失率比较差异无统计学意义(P=0.17)。ICG组的乳房满意度评分高于对照组(P<0.01),但2组患者的胸壁状态满意度、社会心理状态满意度和性生活满意度评分比较差异均无统计学意义(P>0.05)。结论ICG荧光显影可应用于假体重建手术中评估NAC的供血模式,从而指导即刻乳房重建术中植入物的选择,降低严重缺血坏死风险,以便进一步改善术后乳房满意度。Objective To analyze the value of indocyanine green(ICG)fluorescence imaging in the evaluation of blood flown of ipple-areola complex(NAC)and implant selection during single-port endoscopic breast reconstruction.Methods From November 2018 to March 2020,19 patients who underwent single-port inflatable endoscopic nipplesparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital were retrospectively collected.ICG fluorescence imaging technology was used to evaluate the blood supply pattern and the risk of ischemic necrosis of NAC,so as to guide the selection of implant.At the same time,14 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital from February 2017 to October 2018 were selected as the historical control group(control group).NAC ischemic necrosis,breast satisfaction and implant removal were compared between the two groups.Results In the ICG group,there were3 cases of V1 pattern and 2 cases of NAC ischemic necrosis(1 case of grade 1,1 case of grade 2).There was no NAC ischemic necrosis in 16 patients with V2 mode and V3 mode.No implant loss occurred in any of the patients.In the control group,5 cases had NAC ischemic necrosis(all were severe ischemic necrosis),and 2 cases had implant loss.The rate of severe NAC ischemic necrosis in the ICG group was lower than that in the control group(P<0.01),but there was no significant difference in implant loss rate between the two groups(P=0.17).The breast satisfaction score of the ICG group was higher than that of the control group(P<0.01),but there were no significant difference in satisfaction scores of chestwell-being,psychological well-being and sexual well-being between the two groups(P>0.05).Conclusions ICG imaging can be used to evaluate the blood supply pattern during the operation of prosthetic body mass reconstruction,guide the choice of implant in immediate breast reconstruction,so as to further improve postoperative breast satisfaction

关 键 词：乳房重建术 吲哚菁绿 软组织扩张器 假体植入 

分 类 号：R737.9[医药卫生—肿瘤]