带蒂横行腹直肌肌皮瓣联合腹壁下动脉穿支皮瓣乳房再造适应证的探讨  

Exploration of the indications for pedicled transverse rectus abdominis myocutaneous flap combined with deep inferior epigastric artery perforator flap for breast reconstruction

作　　者：袁雨童 徐伯扬 付苏 李尚善 穆大力 辛敏强 陈威威 刘温悦 陈兆瀚 杜星仪 马小睦 付傲 欧阳熠烨 刘春军 栾杰 Yuan Yutong;Xu Boyang;Fu Su;Li Shangshan;Mu Dali;Xin Minqiang;Chen Weiwei;Liu Wenyue;Chen Zhaohan;Du Xingyi;Ma Xiaomu;Fu Ao;Ouyang Yiye;Liu Chunjun;Luan Jie(Department of Oncoplastic and Reconstructive Breast Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China;Department of Mammoplasty,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China;Department of Medical Imaging,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院乳腺综合整形科,北京100144 [2]中国医学科学院北京协和医学院整形外科医院乳房整形科,北京100144 [3]中国医学科学院北京协和医学院整形外科医院影像科,北京100144

出　　处：《中华整形外科杂志》2023年第9期939-946,共8页Chinese Journal of Plastic Surgery

基　　金：中国医学科学院临床与转化医学研究基金(2020-I2M-C&T-B-082);中国医学科学院北京协和医学院整形外科医院院所基金(YS202016)。

摘　　要：目的探讨带蒂横行腹直肌肌皮瓣(TRAM)+腹壁下动脉穿支(DIEP)联合皮瓣适应证选择标准的临床应用价值。方法回顾性分析2008年1月至2022年4月,中国医学科学院整形外科医院乳房整形科和乳腺综合整形科采用双蒂下腹部皮瓣行乳腺癌术后延期乳房再造的患者资料。根据不同血供来源将患者分为TRAM+DIEP联合皮瓣组和双蒂DIEP皮瓣组,比较2组的自体乳房再造特点。TRAM+DIEP联合皮瓣组适应证选择标准:胸部受区无法提供2组吻合血管,腹部供区无优势腹壁下穿支吻合血管,既往行腹部吸脂手术或剥离范围较大、瘢痕较重的腹部手术,无法耐受长时间手术或具有显微外科手术的高风险因素。根据数据资料性质,采用独立样本t检验、秩和检验、卡方检验、Fisher确切概率法分析2组患者的年龄、身体质量指数(BMI)、乳腺癌手术距乳房再造手术时间、放疗史、化疗史、吸烟史、下腹部手术史、高血压史、原手术切口类型、切取皮瓣长度及宽度、手术时间、住院时间、术前及术后情况、术后并发症等,P<0.05为差异具有统计学意义。结果共纳入54例女性患者,均为单侧乳房再造,平均年龄42.2岁(30~59岁),TRAM+DIEP联合皮瓣组21例患者,平均年龄42.7岁(33~56岁);双蒂DIEP皮瓣组33例患者,平均年龄41.8岁(30~59岁)。54例患者最终得到随访38例,其中TRAM+DIEP联合皮瓣组14例,双蒂DIEP皮瓣组24例。TRAM+DIEP联合皮瓣组术后平均随访42个月(6~69个月),发生腹壁膨隆患者1例,发生腹壁疝患者1例;双蒂DIEP皮瓣组术后平均随访47个月(6~179个月),无患者发生腹壁膨隆及腹壁疝。2组患者年龄、BMI、乳腺癌手术距乳房再造手术时间、放疗史、化疗史、吸烟史、下腹部手术史、高血压史、原手术切口类型、切取皮瓣长度及宽度、住院时间、术后患者开始下地活动时间分别比较,差异均无统计学意义(P均>0.05)。TRAM+DIEP联合�Objective This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP)versus pedicled transverse rectus abdominis myocutaneous flap(TRAM)combined with DIEP for breast reconstruction.Methods The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty,Plastic Surgery Hospital,Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed.According to the indications for each procedure,corresponding blood supply source was selected.Subsequently,patients were divided into two groups:bi-pedicled DIEP group and pedicled TRAM+DIEP combined flap group according to the type of blood supply source.The indication selection criteria for pedicled TRAM+DIEP combined flap was as follows:lack of two groups of recipient vessels;no dominant perforator in the abdominal donor site;previous abdominal liposuction or abdominal surgery with large dissection range and severe scar;patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery.A comparison of breast reconstruction surgery characteristics was conducted between the two groups.Independent-samples t-test,rank sum test,Chi-square test and Fisher’s exact probability method were used to analyze various data including age,body mass index(BMI),time interval between breast cancer surgery and breast reconstruction surgery,history of radiotherapy,history of chemotherapy,history of smoking,history of lower abdominal surgery,history of hypertension,original surgical incision type,length and width of flap,hospitalization length,preoperative and postoperative conditions,as well as postoperative complications.Statistical significance was defined at P<0.05.Results A total of 54 patients who underwent unilateral breast reconstruction were included in this st

关 键 词：乳房成形术 肌皮瓣 穿支皮瓣 双蒂腹部皮瓣 联合皮瓣 

分 类 号：R655.8[医药卫生—外科学]