腹壁下动脉穿支皮瓣乳房重建术后并发症对患者报告结局的影响  

Postoperative complications after deep inferior epigastric perforator flap breast reconstruction and their impact on patient-reported outcomes

作　　者：郭旭辉 龚喜龙 肖辉 阳跃 焦得闯 张矫 刘真真 Guo Xuhui;Gong Xilong;Xiao Hui;Yang Yue;Jiao Dechuang;Zhang Jiao;Liu Zhenzhen(Department of Breast Disease,Henan Breast Cancer Center,Tumor Hospital,Zhengzhou University,Zhengzhou 450008,China;Department of Reconstructive and Plastic Surgery,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]郑州大学附属肿瘤医院乳腺科、河南省肿瘤医院乳腺科河南省乳腺癌诊疗中心,郑州450008 [2]北京大学首钢医院修复重建外科,北京100144

出　　处：《中华普通外科杂志》2024年第6期470-475,共6页Chinese Journal of General Surgery

基　　金：河南省医学科技攻关计划项目(LHGJ20210179)。

摘　　要：目的探讨腹壁下动脉穿支皮瓣乳房重建术后并发症的影响因素,以及术后并发症是否会影响患者的生活质量。方法回顾性分析郑州大学附属肿瘤医院乳腺科2019年12月至2023年3月行腹壁下动脉穿支皮瓣乳房重建手术患者的临床及随访资料。结果85例行腹壁下动脉穿支皮瓣乳房重建的患者入组。其中Ⅰ期重建71例,Ⅱ期重建14例。22例(25.9%)出现了术后并发症,11例(12.9%)出现了皮瓣并发症,11例(12.9%)出现了腹部供区并发症。单因素及多因素分析显示,总体并发症发生与高的BMI、早期开展的手术相关(P<0.05),皮瓣并发症与高的BMI、早期开展的手术、术中采用内乳血管的分支作为受区血管有关(P<0.05),而腹部并发症与既往腹部手术瘢痕相关(P<0.05)。BREAST-Q评分显示,与无手术并发症组相比,手术并发症组在乳房满意度、心理健康、躯体健康-胸部、躯体健康-腹部、对腹部的满意度、性健康等维度差异均无统计学意义(P>0.05)。结论腹壁下动脉穿支皮瓣乳房重建存在明显的学习曲线,患者的临床特征(BMI、腹部切口瘢痕)以及术中受区血管的选择可能对患者术后的并发症产生影响,而术后并发症的出现并未对患者报告结局产生影响。Objective To investigate the factors that influence the occurrence of complications following deep inferior epigastric perforator(DIEP)flap breast reconstruction,and to determine whether these complications have an impact on the patient's quality of life.Methods The clinical and follow up data from patients who underwent DIEP flap breast reconstruction at the Department of Breast,Affiliated Cancer Hospital of Zhengzhou University from Dec 2019 to Mar 2023 were retrospectively analyzed.Results A total of 85 patients underwent DIEP flap breast reconstruction,including 71 stage I reconstructions and 14 stage II reconstructions.Postoperative complications occurred in 22 cases 25.9%,including flap complications in 11 cases(12.9%)and abdominal donor site complications in 11 cases(12.9%).Univariate and multivariate analyses showed that the overall incidence of complications was associated with high BMI and early surgery(P<0.05).Flap complications were associated with high BMI,surgery performed at initial phase,and the use of internal mammary vascular branches as recipient vessels(P<0.05).Abdominal complications were associated with previous abdominal surgery scars(P<0.05).BREAST-Q scores showed no significant differences between the surgical complication group and the no complication group in terms of breast satisfaction,mental health,physical health-chest,physical health-abdomen,satisfaction with abdomen,sexual health,etc.(P>0.05).Conclusions DIEP flap breast reconstruction has a significant learning curve.The patient's own clinical characteristics(such as BMI and abdominal incision scars)and intraoperative choices(such as the selection of recipient vessels)may influence the occurrence of postoperative complications.However,the presence of postoperative complications does not appear to have an impact on patient-reported outcomes.

关 键 词：乳腺肿瘤 腹部皮瓣 术后并发症 危险因素 患者报告结局 

分 类 号：R737.9[医药卫生—肿瘤]