保留乳头及乳晕的乳腺癌改良根治术后即刻腹壁下动脉穿支皮瓣重建乳房14例  

Immediate breast reconstruction with deep inferior epigastric artery perforator flap following nipple-areola-sparing modified radical mastectomy in 14 patients with breast cancer

作　　者：肖顺娥 李海 吴祥奎 吴必华 李涛浪 赵洪远 魏在荣 邓呈亮 XIAO Shun'e;LI Hai;WU Xiangkui;WU Bihua;LI Taolang;ZHAO Hongyuan;WEI Zairong;DENG Chengliang(Department of Burn and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou Province 563099,China;The Collaborative Innovation Center of Tissue Damage Repair and Regenerative Medicine of Zunyi Medical University,Zunyi,Guizhou Province 563099,China;Department of General Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou Province 563099,China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,贵州遵义563099 [2]遵义医科大学组织损伤修复与再生医学省部共建协同创新中心,贵州遵义563099 [3]遵义医科大学附属医院普通外科,贵州遵义563099

出　　处：《中华显微外科杂志》2024年第5期514-519,共6页Chinese Journal of Microsurgery

基　　金：贵州省高层次创新型人才"千"层次人才(gzwjrs2023-033);省部共建协同创新中心项目(2020-39)。

摘　　要：目的探讨保留乳头、乳晕的乳腺癌改良根治术后即刻腹壁下动脉穿支皮瓣(DIEPF)重建乳房的效果。方法对2021年11月至2023年3月于遵义医科大学附属医院烧伤整形外科行保留乳头、乳晕的乳腺癌改良根治术同期采用DIEPF行乳房重建患者的临床资料进行回顾分析。共纳入14例患者,年龄29~49(平均40)岁,左侧乳腺癌3例,右侧11例。术前应用CTA明确腹壁下动脉(DIEA)走行及分支情况,定位优势穿支,术中应用吲哚菁绿(ICG)荧光造影评估皮瓣灌注范围及血管吻合口通畅性。4例患者采用单侧穿支DIEPF完成乳房重建,10例采用双侧穿支DIEPF通过内增压后完成乳房重建。7例患者选用胸廓内血管作为受区吻合血管,7例选用胸背血管作为受区吻合血管。切除的乳房组织重量为(325.8±17.1)g,重建乳房的皮瓣重量为(332.9±32.1)g,切取的DIEPF面积为16.0 cm×9.0 cm~24.0 cm×12.0 cm,与受区血管吻合的皮瓣血管蒂长度为(11.4±1.5)cm。皮瓣供区行逐层减张缝合,重新定位脐的位置并缝合。所有患者出院后通过门诊定期随诊。结果14例患者术后皮瓣均未发生血管危象,受区及供区均一期愈合。随访6~16个月,平均11个月,未出现乳腺癌复发病例,乳房重建效果均较满意,未出现明显并发症。结论保留乳头、乳晕的乳腺癌改良根治术后即刻行DIEPF乳房重建,可获得良好的美学效果,供区并发症少,患者满意度高。Objective To investigate the effect of immediate breast reconstruction with a deep inferior epigastric artery perforator flap(DIEPF)after the modified radical mastectomy with nipple and areola preservation for breast cancer.Methods Clinical data from November 2021 to March 2023 of 14 patients with ages from 29 to 49(mean 40)years old were retrospectively analysed.All the patients received nipple-areola complex-preserving modified radical mastectomy for breast cancer followed by breast reconstruction with DIEPF at the Department of Burn and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University.Three patients had left breast cancer and 11 had right breast cancer.Preoperative CTA was used to clarify the course and branching of the deep inferior epigastric artery(DIEA)and identify dominant perforators.Intraoperatively,indocyanine green(ICG)angiography was conducted to assess the perfusion of the flap and patency of the vascular anastomoses.Reconstructive surgery were performed using unilateral DIEPF in 4 patients and bilateral DIEPF with internal pressurization in 10 patients.Seven patients underwent anastomosis with intrathoracic vessels as recipient vessels,and 7 with thoracodorsal vessels.The weight of the resected breast tissue was 325.8 g±17.1 g,and the weight of the reconstructed breast flap was 332.9 g±32.1 g.The size of the harvested DIEPF ranged from 16.0 cm×9.0 cm to 24.0 cm×12.0 cm,with the length of the vascular pedicle anastomosed to the recipient vessels at 11.4 cm±1.5 cm.The donor sites were closed by layers with tension-reducing sutures,and the position of the umbilicus was relocated and sutured.All patients were included in the scheduled postoperative follow-up at the outpatient clinic after discharge.Results Of all 14 patients,no postoperative crisis compromise of flap occurred,and both the recipient and donor sites healed primarily.During a follow-up period of 6 to 16 months,with an average of 11 months,no breast cancer recurrence was observed,and the aesthetic outcomes of the

关 键 词：乳房重建 腹壁下动脉穿支皮瓣 乳腺癌改良根治术 血管吻合 

分 类 号：R737.9[医药卫生—肿瘤]