游离皮瓣移植乳房再造的严重并发症及补救措施  

Serious complications and salvage methods in breast reconstruction with free flap transplantation

作　　者：王柚熙 刘旭 王志远[2] 宋达疆[3] 李赞[3] Wang Youxi;Liu Xu;Wang Zhiyuan;Song Dajiang;Li Zan(Department of Oncological Surgery,Shannri People's Hospital,Xi'an 710068,China;Department of Diagnostic Ultrasound,Hunan Cancer Hospital,Changsha 410008,China;Department of Oncology and Plastic Surgery,Hunan Cancer Hospital,Changsha 410008,China)

机构地区：[1]陕西省人民医院肿瘤外科,西安710068 [2]湖南省肿瘤医院超声诊断中心,长沙410008 [3]湖南省肿瘤医院肿瘤整形外科,长沙410008

出　　处：《中华医学美学美容杂志》2024年第4期359-364,共6页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：湖南省卫生健康委员会科研项目(202209024847);湖南省自然科学基金科卫联合项目(2023JJ60334)

摘　　要：目的探讨游离皮瓣移植乳房再造的严重并发症及其补救措施和经验。方法回顾性纳入2015年9月至2021年12月湖南省肿瘤医院就诊的乳腺癌乳房再造女性患者395例, 年龄28~61 (43.6±4.7)岁。术中及术后发生并发症45例, 其中严重并发症21例, 主要术式:(1)游离股薄肌皮瓣联合大收肌穿支皮瓣移植;(2)游离大收肌穿支皮瓣移植;(3)带蒂腹直肌皮瓣移植;(4)带蒂背阔肌皮瓣移植;(5)假体;(6)移植血管;(7)血管重新吻合;(8)血管卡压区域松解。结果 21例严重并发症患者再次手术补救方法:(1)血管蒂张力过大或摆放成角卡压3例, 其中1例成功挽救;2例皮瓣失败中, 1例用假体补救, 1例用游离股薄肌皮瓣移植联合大收肌穿支皮瓣补救;(2)血管吻合质量不高导致血管栓塞1例, 通过血管重新吻合成功补救;(3)受区血管性状不佳1例, 皮瓣坏死并用带蒂背阔肌皮瓣移植补救;(4)患者依从性差3例, 其中1例成功挽救, 另外2例皮瓣坏死, 分别用游离大收肌穿支皮瓣和游离股薄肌皮瓣联合大收肌穿支皮瓣移植补救;(5)患者月经发作2例, 导致皮瓣坏死, 分别用游离股薄肌皮瓣联合大收肌穿支皮瓣和游离大收肌穿支皮瓣移植补救;(6)皮瓣修剪过度影响血运1例, 皮瓣坏死, 用游离大收肌穿支皮瓣移植补救;(7)10例皮下血肿予以清创探查手术, 全部成功补救。结论游离皮瓣移植乳房再造发生并发症和失败不能完全避免, 掌握相应的补救方法非常重要。Objective To summarize the serious complications and salvage methods and experience of breast reconstruction with free flap transplantation.Methods Different techniques of free flap transplantation were used for breast reconstruction in 395 breast cancer patients who came to Hunan Cancer Hospital from September 2015 to December 2021.45 complications occurred during and after surgery,including 21 serious complications.Corresponding salvage method was used for complications and flap failure.Salvage methods included free gracilis myocutaneous flap combined with adductor magnus perforator flap,free adductor magnus perforator flap transplantation,pedicled rectus abdominis flap transplantation,pedicled latissimus dorsi myocutaneous flap,prosthetic replacement,vascular grafting,vascular reanastomosis and release of vascular tension area.Results The specific causes and salvage methods in 21 cases of reoperation included:3 cases of excessive tension or compression of vascular pedicle,of which 1 case was successfully salvaged;in 2 cases flap failure was occurred,of which 1 case was replaced with prosthesis,and 1 case was salvaged with free gracilis myocutaneous flap combined with adductor magnus perforator flap;one case of vascular embolism caused by poor quality of vascular anastomosis was successfully salveged by vascular re anastomosis.One case had poor recipient vessels,and the flap failure was salvaged with pedicled latissimus dorsi flap.Three patients had poor compliance,of which one case was successfully salvaged,and the other two cases had total flap failure,which were repaired by free adductor magnus perforator flap and free gracilis myocutaneous flap combined with adductor magnus perforator flap respectively.Two patients had menstrual postoperatively,resulting in flap failure.Free gracilis myocutaneous flap combined with adductor magnus perforator flap and free adductor magnus perforator flap were used for breast reconstruction respectively.In 1 case,the blood supply was affected by excessive flap trimming,and th

关 键 词：乳房成形术 手术后并发症 皮瓣坏死 游离皮瓣 乳房再造 补救 

分 类 号：R655.8[医药卫生—外科学]