增压带蒂腹直肌皮瓣用于乳房再造的效果  

Effect of supercharged pedicled rectus abdominis flap for breast reconstruction

作　　者：朱敬军[1] 杨丽仪 李赞 宋达疆 Zhu Jingjun;Yang Liyi;Li Zan;Song Dajiang(Department of Breast Surgery,Baotou Cancer Hospital of Inner Mongolia Autonomous Region,the Affiliated Cancer Hospital of Baotou Medical College,Baotou O14030,China;Department of Thyroid and Breast Surgery,Jiangyin People's Hospital,Jiangyin 214400,China;Department of Oncology Plastic Surgery,the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University/Hunan Cancer Hospital,Changsha 410008,China)

机构地区：[1]内蒙古自治区包头市肿瘤医院,包头医学院附属肿瘤医院乳腺外科,包头014030 [2]江苏江阴市人民医院乳腺甲状腺外科,江阴214400 [3]中南大学湘雅医学院附属肿瘤医院,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5期430-434,共5页Chinese Journal of Medical Aesthetics and Cosmetology

摘　　要：目的探讨增压带蒂腹直肌皮瓣用于乳房再造的效果。方法回顾性纳入2019年3月至2022年12月湖南省肿瘤医院肿瘤整形外科收治乳腺癌术后采用增压带蒂腹直肌皮瓣移植的方法行Ⅰ期即刻乳房再造女性患者37例,年龄29~61(37.7±3.5)岁。根据术前影像学及超声资料,17例患者术前计划用游离腹壁下动脉穿支皮瓣移植完成乳房即刻重建,术中根据实际情况调整为直接制备携带长段腹壁下血管蒂的带蒂腹直肌皮瓣。另外,20例患者术前计划采用单纯带蒂腹直肌皮瓣,术中根据实际情况改为采用增压带蒂腹直肌皮瓣。根据受区情况及术中即刻荧光造影情况修剪皮瓣。断蒂后置入受区,选择受区血管进行血管吻合,塑形后缝合供、受区。观察皮瓣存活情况。结果术中以荧光造影判断皮瓣血运情况,发现37例带蒂腹直肌皮瓣均有不同程度的血运障碍区域。吻合携带的腹壁下血管蒂后,37例肌皮瓣完全成活。具体吻合的受区血管包括胸廓内血管(19例,51.4%)、胸外侧动静脉(10例,27.0%)和胸背血管前锯肌支(8例,21.6%)。在37例皮瓣中均携带了一侧腹壁浅静脉,其中20例携带同侧腹壁浅静脉,17例携带对侧腹壁浅静脉,其中6例额外吻合腹壁浅静脉,实际利用率为16.2%。随访9~47个月,平均22.7个月。37例患者再造乳房外形尚可、弹性较好、无皮瓣挛缩变形。皮瓣供区仅遗留线性瘢痕,腹壁功能无影响。结论增压带蒂腹直肌皮瓣用于乳房再造可提高皮瓣成活率及手术安全性。ObjectiveTo investigate the effect of pressurized pedicled rectus abdominis flap for breast reconstruction.MethodsA retrospective study was conducted to include 37 female patients with breast cancer who underwent immediate breast reconstruction using a pressurized pedicle rectus abdominis skin flap transplantation after surgery at the Department of Plastic and Reconstructive Surgery,Hunan Provincial Cancer Hospital from March 2019 to December 2022.The patients were aged 29-61 years,with an average age of(37.7±3.5)years.According to the preoperative imaging and ultrasound data,17 patients were planned to complete immediate breast reconstruction with free inferior abdominal artery perforator flap transplantation,and the operation was adjusted to directly prepare a pedicled rectus abdominis flap with long inferior abdominal vessel pedicle according to the actual situation.In addition,20 patients were scheduled to use pedicled rectus abdominis flap alone,and the operation was changed according to the actual situation.The flap was trimmed according to the condition of the affected area and immediate intraoperative fluorgraphy.After cutting off the vascular pedicle,the recipient area was placed,and the recipient blood vessels were selected for vascular anastomosis.After shaping,the donor and recipient areas were sutured.The survival of the skin flap was observed.ResultsIntraoperative fluorescein angiography was used to determine the blood supply of the flap.It was found that 37 cases of pedicled rectus abdominis flaps had different degrees of blood supply disorders.The affected vessels in the specific anastomosis comprised the intrathoracic vessels(19 cases,51.4%),the lateral thoracic arterial vein(10 cases,27.0%),and anterior branches of the thoracic and dorsal vessels(8 cases,21.6%).In 37 cases,the lateral abdominal wall vein was carried in the flap,20 of which carried the lateral abdominal wall shallow vein,17 cases carried the lateral abdominal wall shallow vein,six of which were extra anastomosed and superficial

关 键 词：乳腺肿瘤 带蒂肌皮瓣 腹直肌皮瓣 腹壁下动脉 增压 乳房再造 

分 类 号：R737.9[医药卫生—肿瘤]