腹部皮瓣乳房再造术后并发症的危险因素分析  

Risk factors of postoperative complications of breast reconstruction with abdominal flaps

作　　者：苏聪 王庶 丁泊文 何珊珊 韩春勇 殷竹鸣 尹健 Su Cong;Wang Shu;Ding Bowen;He Shanshan;Han Chunyong;Yin Zhuming;Yin Jian(Department of Breast Oncoplastic Surgery,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin,Tianjin's Clinical Research Center for Cancer,Key Laboratory of Breast Cancer Prevention and Therapy,Tianjin Medical University,Ministry of Education,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院乳房再造科、国家恶性肿瘤临床医学研究中心、天津市肿瘤防治重点实验室、天津市恶性肿瘤临床医学研究中心、乳腺癌防治教育部重点实验室、中俄乳腺肿瘤整形联合研究中心,天津300060

出　　处：《中华普通外科杂志》2024年第7期539-543,共5页Chinese Journal of General Surgery

基　　金：天津市医学重点学科(专科)建设项目基金资助项目(TJYXZDXK-009A);天津市“项目+团队”重点培养专项基金资助项目(XB202008)。

摘　　要：目的探讨腹部皮瓣乳房再造术后并发症及相关危险因素。方法回顾性分析2011年1月至2022年4月天津医科大学肿瘤医院乳房再造科行腹部皮瓣乳房再造484例患者的临床资料。结果484例患者中95例(19.6%)出现术后并发症,其中15.5%发生皮瓣并发症,5.2%发生供区并发症,脂肪坏死是发生率最高的并发症(11.9%),通过技术改进脂肪液化率较前大幅下降(1.7%比7.0%)。单因素分析结果表明,再造术式、新辅助化疗史、BMI、吸烟史均与术后并发症有关(χ^(2)=21.088,P<0.001;χ^(2)=4.385,P=0.036;χ^(2)=14.784,P=0.018;χ^(2)=19.015,P=0.048),再造时机及术式均与非计划再次手术有关(χ^(2)=7.316,P=0.007;χ^(2)=17.167,P<0.001),再造时机、放疗时序均与修整手术有关(χ^(2)=40.785,P<0.001;χ^(2)=18.602,P<0.001);多因素分析结果表明,腹壁下动脉穿支皮瓣、吸烟史是皮瓣坏死的独立危险因素(OR=0.084,95%CI:0.022~0.325,P<0.001;OR=41.623,95%CI:3.241~534.569,P=0.004)。结论腹部皮瓣乳房再造术后并发症与多种因素有关,术前应详细评估手术风险,制定个性化方案。ObjectiveTo study the postoperative complications and its risk factors in patients undergoing breast reconstruction with abdominal flaps.MethodsThe clinical data of patients undergoing breast reconstruction with abdominal flaps at Department of Breast Oncoplastic Surgery,Tianjin Medical University Cancer Institute and Hospital from Jan 2011 to Apr 2022 were reviewed.ResultsPostoperative complications occurred in 95 of 484 patients(19.6%),15.5%had flap complications,5.2%had donor-site complications,and fat necrosis was the most common complication(11.9%).The rate of fat liquefaction decreased significantly through technical improvement(1.7%vs.7.0%);By univariate analysis,there were statistically significant differences among the groups by reconstructive type,neoadjuvant chemotherapy,BMI,smoking history(χ^(2)=21.088,P<0.001;χ^(2)=4.385,P=0.036;χ^(2)=14.784,P=0.018;χ^(2)=19.015,P=0.048).Unplanned reoperation statistically related to the timing of reconstruction,and reconstructive type(χ^(2)=7.316,P=0.007;χ^(2)=17.167,P<0.001).Revision surgery significantly related to the timing of reconstruction and timing of radiation(χ^(2)=40.785,P<0.001;χ^(2)=18.602,P<0.001);By multivariate analysis,deep inferior epigastric perforator flap,smoking history were independent risk factors for flap necrosis(OR=0.084,95%CI:0.022-0.325,P<0.001;OR=41.623,95%CI:3.241-534.569,P=0.004).ConclusionsComplications after breast reconstruction with abdominal flaps are related to many factors.The surgical risks should be carefully evaluated and personalized plan should be formulated before surgery.

关 键 词：乳房成形术 术后并发症 危险因素 

分 类 号：R655.8[医药卫生—外科学]