带蒂内乳动脉穿支皮瓣在内下象限乳腺癌保乳术中的应用  

Clinical application of pedicled internal mammary artery perforator flap for oncoplastic breast-conserving surgery in lower quadrant of breast cancer

作　　者：屈洪波 朱芳 何建怀 王先明[1] QU Hongbo;ZHU Fang;HE Jianhuai;WANG Xianming(Department of Thyroid and Breast Surgery,South China Hospital of Shenzhen University,Shenzhen 518000,Guangdong,China;Health Management Department,Longhua District People’s Hospital,Shenzhen 518000,Guangdong,China;Department of Thyroid and Breast Surgery,The First People’s Hospital of Chenzhou,Chenzhou 423000,Hunan,China)

机构地区：[1]深圳大学附属华南医院甲乳外科,深圳518000 [2]深圳市龙华区人民医院健康管理科,深圳518000 [3]郴州市第一人民医院甲乳外科,郴州423000

出　　处：《中国临床医学》2024年第1期121-125,共5页Chinese Journal of Clinical Medicine

基　　金：郴州市科技创新引导专项课题(ZDYF2020032)。

摘　　要：目的 探讨采用带蒂内乳动脉穿支(internal mammary artery perforator, IMAP)皮瓣修复内下象限乳腺癌保乳术后乳房局部缺损的可行性及美容效果。方法 回顾性分析2018年2月—2021年2月郴州市第一人民医院甲乳外科收治的12例乳腺癌患者临床资料。所有患者肿瘤均位于内下象限,所有患者均采用带蒂IMAP皮瓣修复保乳术后乳房局部缺损,记录每次穿支血管解剖情况,观察手术相关指标(皮瓣制作时间、切除病灶组织量、手术时间及切缘二次扩切率)及术后并发症,评价术后美容效果。结果 12例患者的整形保乳术均成功完成,术中发现内乳动脉穿支血管相对恒定,皮瓣制作耗时为(12±2)min。术中切除病灶组织量为(98.0±16.5)g,手术时间为(105±15)min,切缘二次扩切率为16.7%。术后有1例出现皮瓣尖端坏死及1例皮下脂肪液化,经换药后均痊愈,余10例均一期愈合,术后并发症发生率为16.7%。术后美容效果评价优良率为91.7%,术后平均随访36个月,未见局部复发,仅1例出现骨转移。结论 采用带蒂IMAP皮瓣修复内下象限乳腺癌保乳术后局部缺损,手术可操作性强,创伤小,美容效果好,值得临床推广。Objective To investigate the feasibility and aesthetic effect of pedicled internal mammary artery perforator(IMAP)flap for repairing local defect of breast-conserving surgery in lower quadrant.Methods Clinical data of 12 patients with breast cancer admitted to the First People’s Hospital of Chenzhou from February 2018 to February 2021 were retrospectively analyzed.The tumors were all located in the lower inner quadrant.Pedicled IMAPflap was used to repair local defects after breast-conserving surgery,and the anatomy of each perforator vessel was recorded.The operative indicators(time offlap making,amount of focal tissue resected,operative time and secondary expansion rate of resection margin)and postoperative complications were observed,and the postoperative cosmetic effect was evaluated.Results All 12 patients underwent breast-conserving surgery successfully.The perforating vessels of internal mammary artery were found to be relatively constant,and the average time of makingflap was(12±2)min.The average intraoperative amount of lesion tissue was(98.0±16.5)g,the average operative time was(105±15)min,and the secondary expansion rate of edge was 16.7%.There were 1 case of necrosis at the tip of theflap and 1 case of liquefaction of subcutaneous fat.Both healed after drug change.The remaining 10 cases healed at thefirst stage.The incidence of postoperative complications was 16.7%.The rate of excellent and good of postoperative cosmetic effect evaluation was 91.7%.The mean follow-up time was 36 months.No local recurrence was found,and only 1 case had bone metastasis.Conclusions Pedicled IMAPflap can repair the local defect after breast-conserving surgery in the lower quadrant of the breast cancer,which has strong operability,little trauma and good cosmetic effect,and is worthy of clinical promotion.

关 键 词：乳腺肿瘤 内乳动脉穿支皮瓣 整形保乳术 

分 类 号：R737.9[医药卫生—肿瘤]