腔镜腹壁下动脉穿支皮瓣乳房重建术技术要点  

Laparoscopically assisted deep inferior epigastric artery perforator flap breast reconstruction:Indications and technical highlights

作　　者：殷竹鸣 何珊珊 苏聪 孙敬岩 尹健 YIN Zhu-ming;HE Shan-shan;SU Cong;YIN Jian(Department of Breast Oncoplastic Surgery,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer(Tianjin),Center for Breast Cancer Prevention and Therapy,Tianjin,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)、中国天津乳腺癌防治研究中心、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：《中国实用外科杂志》2024年第11期1211-1215,共5页Chinese Journal of Practical Surgery

基　　金：天津市医学重点学科(专科)建设项目(No.TJYXZDXK-009A);天津市“项目+团队”重点培养专项基金资助项目(No.XB202008)。

摘　　要：腹壁下动脉穿支(DIEP)皮瓣是自体组织乳房重建最常用的术式。经典DIEP皮瓣切取术式需要跨越弓状线的腹直肌前鞘切口,可出现肋间神经过度牵拉等供区损伤,导致腹壁薄弱、膨隆甚至腹壁疝的发生。因此,需探索微创DIEP皮瓣切取技术。腔镜全腹膜外入路(TEP)和机器人辅助经腹腔腹膜前入路(TAPP)是现阶段两种主流的微创DIEP皮瓣切取技术。因为机器人辅助技术耗时长、费用高,并且TAPP入路存在腹腔器官干扰和腹膜损伤,腔镜TEP-DIEP皮瓣切取术更适宜推广应用。经典DIEP皮瓣切取手术适应证均适用于腔镜TEP-DIEP皮瓣切取手术。目前尚缺乏该术式的规范化要求,基于文献报道及实践经验,推荐采用“直角三角形”布孔,镜头推挤法建腔,“两轮法”逆行剥离血管蒂。期待未来开展腔镜TEP-DIEP与传统DIEP皮瓣切取手术的对比研究,为该术式的推广提供循证医学证据。The deep inferior epigastric artery perforator(DIEP)flap is the most commonly used procedure for autologous breast reconstruction.The classic technique for DIEP flap harvest requires a trans-Arcuate-line incision on the rectus sheath and may result in excessive traction on the intercostal nerves,leading to donor-site morbidity such as abdominal wall weakness,bulging,and even hernia.Therefore,it is essential to explore minimally invasive techniques for harvesting DIEP flaps.The laparoscopically assisted totally extraperitoneal(TEP)approach and the robot-assisted transabdominal preperitoneal(TAPP)approach are currently the two mainstream representative techniques for minimally invasive DIEP flap harvest.Given that the robotic-assisted technique is time-and money-consuming,and the TAPP approach poses risks of interference with the function of abdominal organs and damage to the peritoneum,the TEP technique for DIEP flap harvest is more suitable to be taken as a standard method.Deep understanding of the indications and technical highlights of the TEP technique is of great significance for spreading the concept and standardizing the application of minimally invasive DIEP flap harvest for breast reconstruction.It is expected to make a head-to-head comparison between laparoscopically assisted TEP-DIEP harvest and traditional DIEP maneuvers for breast reconstruction in the future.

关 键 词：乳腺癌 乳房重建 腹壁下动脉穿支皮瓣 腔镜外科 

分 类 号：R6[医药卫生—外科学]