保留外侧部分腹直肌的带蒂腹直肌皮瓣移植再造乳房  

Breast reconstruction with pedicled rectus abdominis flap preserving the lateral part of rectus abdominis

作　　者：宋达疆[1] 李赞[1] 章一新[2] 周波[1] 吕春柳[1] 唐园园 易亮 罗振华 Song Dajiang;Li Zan;Zhang Yixin;Zhou Bo;Lyu Chunliu;Tang Yuanyuan;Yi Liang;Luo Zhenhua(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复外科,上海200011

出　　处：《中华解剖与临床杂志》2023年第1期51-55,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨保留外侧部分腹直肌的带蒂腹直肌皮瓣移植再造乳房的临床疗效。方法系列病例报告研究。纳入2021年8月—2022年2月湖南省肿瘤医院采用保留外侧部分腹直肌的带蒂腹直肌皮瓣移植再造乳房的11例乳腺癌女性患者,年龄32~57岁(平均45.1岁)。均为乳腺癌改良根治术后即刻乳房再造。切取皮瓣长22~30(24.5±0.8)cm,皮岛宽10~12(11.2±0.5)cm。具体制备肌皮瓣形式包括:类型Ⅰ,一侧传统带蒂腹直肌皮瓣联合对侧保留外侧部分腹直肌的带蒂腹直肌皮瓣移植;类型Ⅱ,双侧保留外侧部分腹直肌的带蒂腹直肌皮瓣移植;类型Ⅲ,一侧保留外侧部分腹直肌的带蒂腹直肌皮瓣联合对侧游离腹壁下动脉穿支皮瓣移植。观察皮瓣血运情况、并发症和随访情况。结果11例患者的皮瓣制备类型Ⅰ4例、类型Ⅱ4例、类型Ⅲ3例。所有皮瓣顺利成活,未见明显并发症。11例患者均获随访,随访时间6~12个月,平均9.4个月。再造乳房外形可,质地满意,无皮瓣挛缩变形;皮瓣供区仅遗留线性瘢痕,腹壁功能无明显影响。结论保留外侧部分腹直肌的带蒂腹直肌皮瓣制备手术难度不大,能有效减小供区损伤,获得满意的手术效果,可以作为乳腺癌术后乳房再造较好的手术方法选择。Objective To explore the clinical effect of breast reconstruction with pedicled rectus abdominis skin flap with the lateral part of the rectus abdominis preserved.Methods Eleven female patients with breast cancer underwent breast reconstruction with the pedicled rectus abdominis myocutaneous flap preserving the lateral part of the rectus abdominis muscle in Hunan Cancer Hospital between August 2021 and February 2022.The patients'age was in the range of 32-57 years with an average of 45.1 years.All patients underwent immediate breast reconstruction after modified radical mastectomy for breast cancer.The flap length was 22-30(24.5±0.8)cm,and the width of the skin paddle was 10-12(11.2±0.5)cm.The specific forms of myocutaneous flaps included:typeⅠ,the traditional pedicled rectus abdominis myocutaneous flap on one side combined with the contralateral pedicled rectus abdominis myocutaneous flap with the lateral part of the rectus abdominis preserved;typeⅡ,bilateral pedicled rectus abdominis flap with the lateral part of the rectus abdominis preserved on both sides;typeⅢ,a pedicled rectus abdominis flap with the lateral part of the rectus abdominis preserved combined with the contralateral free deep inferior epigastric artery perforator flap.Flap blood supply,complication rate,and follow-up were observed.Results The specific flap harvest forms included four cases of typeⅠ,four cases of typeⅡ,and three cases of typeⅢ.All flaps survived smoothly without obvious complications.All patients were followed up for 6-12 months with an average of 9.4 months.The reconstructed breasts had satisfactory appearance and texture without flap contracture and deformation.Only linear scar was left in the donor site,and the abdominal wall function was not remarkably affected.Conclusion The pedicled rectus abdominis myocutaneous flap with the preservation of the lateral rectus abdominis muscle is not difficult to harvest,which can effectively reduce donor site morbidity,achieve satisfactory outcomes,and can be used as a surgic

关 键 词：乳房成形术 乳腺肿瘤 腹直肌皮瓣 带蒂皮瓣 

分 类 号：R737.9[医药卫生—肿瘤]