新型脐周按钮式切口在横向腹直肌肌瓣乳房重建中的应用  

Novel button-shaped incision for harvestingg transverse rectus abdominis musculocutaneous flap in breast reconstruction

作　　者：李婷婷 崔翔 刘静 吴鑫 杨汐 陈莉 Li Tingting;Cui Xiang;Liu Jing;Wu Xin;Yang Xi;Chen Li(Department of Breast and Thyroid Surgery,First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院乳腺甲状腺外科,重庆400038

出　　处：《中华乳腺病杂志（电子版）》2023年第6期347-352,共6页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的初步探讨新型脐周按钮式切口在横向腹直肌肌瓣乳房重建中的应用。方法2023年3~4月陆军军医大学第一附属医院收治的2例乳腺癌患者接受保留乳头乳晕的乳房皮下腺体切除术联合按钮式切口获取横向腹直肌皮瓣(TRAM)乳房重建术。手术步骤包括保留乳头乳房切除术,通过围绕肚脐的正圆形切口获取TRAM肌瓣,环形去表皮,转移腹部皮瓣整形并缝合,腹部切口进行荷包缝合。术后定期评估腹部及乳房的美容效果。结果2例患者手术均顺利完成,手术时间分别为446min和299min,术中出血量均为100ml。术后腹部切口处无感染、血肿等并发症,乳房重建的肌皮瓣无缺血、坏死。术后1.5个月和3个月随访结果显示,与传统手术相比,使用按钮式切口技术的腹部伤口明显缩短且隐蔽。结论通过新型按钮式切口获取TRAM是一种可行的乳房重建技术,具有创伤小、术后瘢痕隐蔽等优势。Objective To explore the application of the new periumbilical button-shaped incision in breast reconstruction with transverse rectus abdominis musculocutaneous(TRAM)flap.Methods Nipple-sparing mastectomy combined with breast reconstruction with TRAM flaps harvested via an button-shaped incision was performed in two breast cancer patients in the First Affiliated Hospital of Army Medical University in March and April 2023.The operative steps included performing nipple-sparing mastectomy,making a button incision,separating subcutaneous tissues and harvesting the lateral rectus abdominis muscle flap,de-epithelializing circumferential skin,transferring abdominal skin flap for shaping and suturing,and purse-string suturing for abdominal incision.Postoperative cosmetic results of the abdomen and the breast were assessed monthly.Results The surgery was successfully accomplished in the two cases.The operation time was 446 min and 299 min,respectively.Intraoperative blood loss was 100 ml in both cases.There was no postoperative infection or hematoma in the area of abdominal incision.No ischemia or necrosis of the reconstructed flap in the breast occurred.The results at 1.5 and 3 months follow-ups showed a significantly smaller and more occult abdominal scar compared with other patients receiving conventional surgery.Conclusion Button-shaped incision for harvesting TRAM flap is a feasible technique for breast reconstruction,with the advantages of small trauma and concealed postoperative scars.

关 键 词：外科切口 肌皮瓣 乳房重建 

分 类 号：R737.9[医药卫生—肿瘤]