胸背动静脉远近心端为受区血管的腹壁下动脉穿支皮瓣即刻乳房再造术4例  

Proximal and distal ends of thoracodosal artery and vein as recipient vessels for immediate breast reconstructions using deep inferior epigastric perforator flap in four cases

作　　者：陈秀秀 吴煌福 穆籣 郑武平[1] 潘俊博 何贵省 宋韬 张亚珍 陈恒余 黄菁慧 许艺莲 Chen Xiuxiu;Wu Huangfu;Mu Lan;Zheng Wuping;Pan Junbo;He Guisheng;Song Tao;ZhangYazhen;Chen Hengyu;Huang Jinghui;Xu Yilian(Department of Breast and Thyroid Surgery,the Second Afiliated Hospital of Hainan Medical College,Haikou 570000,China;Department of Plastic Surgery,the Second Affliated Hospital of Hainan Medical College,Haikou 570000,China;Department of Plastic and Reconstructive Surgery,the Second Affiliated Hospital of Hainan Medical College,Haikou 570000,China;Department of Radiology,the Second Affiliated Hospital of Hainan Medical College,Haikou 570000,China)

机构地区：[1]海南医学院第二附属医院乳甲外科,海口570000 [2]海南医学院第二附属医院整形外科,海口570000 [3]海南医学院第二附属医院整复外科,海口570000 [4]海南医学院第二附属医院放射科,海口570000

出　　处：《中华整形外科杂志》2024年第5期507-513,共7页Chinese Journal of Plastic Surgery

基　　金：海南省卫生健康行业科研项目(21A200275)。

摘　　要：目的探讨胸背动静脉远、近心端作为即刻乳房再造胸部受区血管的可行性和优点。方法回顾性分析2022年3月至2023年6月,海南医学院第二附属医院乳甲外科收治的应用胸背血管远、近心端同时作为受区血管的乳房再造术的患者临床资料。术前行胸腹部血管造影检查及彩色多普勒超声定位腹壁下血管主干及其穿支。先行乳腺切除及腋窝淋巴结清扫术,然后分离腹部皮瓣双侧穿支和主干血管,再离断双侧腹壁下动脉主干、暴露血管蒂,分别与胸背动静脉远、近心端行端端吻合。然后经切口将塑形好的皮瓣植入乳腺切除后的腔隙内,行再造乳房塑形摆位,患者屈膝曲髋位调整再造乳房形态,关闭腹部供区,重建脐孔,放置负压引流管,关闭乳房切口。术后随访观察皮瓣并发症的发生情况,并调查患者对再造乳房的满意度。结果共纳入4例女性患者,年龄(46.0±6.5)岁(37~52岁)。4例患者供区血管均为双侧腹壁下血管蒂,3例受区血管为胸背血管远、近心端,1例为胸背血管前锯肌支的远、近心端。术后7~10 d拔除全部引流管,顺利出院。术后随访1~15个月,平均6个月,患者恢复良好,未发生皮瓣相关并发症。4例患者对再造乳房效果均很满意。结论胸背动静脉远、近心端的同时应用既可保证腹壁下动脉穿支皮瓣的成活,又减少了对肋骨、肋间肌的损伤,达到了更好的乳房美学效果。Objective Explore the feasibility and advantages of using proximal and distal ends of thoracodosal artery and vein as recipient vessels in deep inferior epigastric perforator flap immediate breast reconstruction.Methods The clinical data of patients who underwent breast reconstruction surgery using the proximal and distal ends of the thoracodorsal vein as recipient vessels at the Department of Breast and Thyroid Surgery of the Second Affiliated Hospital of Hainan Medical University from March 2022 to June 2023 were analyzed retrospectively.Preoperative examinations included thoracoabdominal angiography and color Doppler ultrasonic localization of the main trunk and perforators of the inferior epigastric vessels.The procedure began with mastectomy and axillary lymph node dissection,followed by the isolation of bilateral perforators and the main trunk of the abdominal flap.The main trunks of the bilateral inferior epigastric arteries were then transected,and their vascular pedicles exposed and anastomosed respectively to the proximal and distal ends of the thoracodorsal artery and vein.Both arteries and veins were joined end-to-end.The flap after trimming and reconstruction was then implanted into the cavity left after mastectomy through the incision.Breast positioning was performed with the patient in a knee-bent and hip-flexed position.After adjusting the shape of the reconstructed breast.The donor site was closed,the umbilicus was reconstructed,drainage tubes were placed,and the breast incision was closed.Postoperative follow-up monitored complications associated with the flap and patient satisfaction with the breast reconstruction,utilizing a self-assessment method.Results Four female patients were included,aged(46.0±6.5)years,ranging from 37 to 52 years.All four patients had bilateral vascular pedicles in the donor area,with three patients having thoracodorsal vessels at the distal and proximal ends as recipient vessels,and one patient having anterior serratus branch of the thoracodorsal vessels at the distal

关 键 词：乳腺肿瘤 腹壁下动脉穿支皮瓣 即刻乳房再造 胸背动脉 胸背静脉 

分 类 号：R655.8[医药卫生—外科学]