补救性带蒂腹直肌皮瓣移植再造乳房的效果及安全性  

Effect and safety of remedial pedicled rectus abdominis myocutaneous flap transplantation for breast reconstruction

作　　者：祝旭龙 刘岩青 宋达疆[3] 李赞[3] 王志远[4] 刘旭 李建辉[1] Zhu Xulong;Liu Yanqing;Song Dajiang;Li Zan;Wang Zhiyuan;Liu Xu;Li Jianhui(Department of Surgical Oncology,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of Breast Surgery,Yantai Yuhuangding Hospital,Yantai 264000,China;Department of Oncology and Plastic Surgery,Hunan Province Cancer Hospital and Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410008,China;Ultrasound Diagnosis Center,Hunan Province Cancer Hospital and Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410008,China)

机构地区：[1]陕西省人民医院肿瘤外科,西安710068 [2]烟台毓璜顶医院乳腺外科,烟台264000 [3]湖南省肿瘤医院肿瘤整形外科,长沙410008 [4]湖南省肿瘤医院超声诊断中心,长沙410008

出　　处：《中华医学美学美容杂志》2025年第2期104-109,共6页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：湖南省卫生健康委科研计划课题(202209024847);陕西省自然科学基础研究计划(2023-JC-YB-345);国家重点研发计划(2022YFE0104200)。

摘　　要：目的探讨补救性带蒂腹直肌皮瓣移植再造乳房的效果及安全性。方法回顾性纳入2022年6月至2023年6月湖南省肿瘤医院采用补救性带蒂腹直肌皮瓣技术完成自体乳房再造的23例女性乳腺癌患者,年龄24~56(43.2±1.3)岁。所有患者均在完成乳房及肿瘤切除术后接受补救性带蒂腹直肌皮瓣移植再造乳房。采用门诊及电话访谈的方式进行随访,随访时间为10(6~15)个月。观察指标包括皮瓣成活率、患者满意度和美学效果等。记录手术过程中以及术后皮瓣挛缩变形、腹壁功能受损等不良反应发生情况。结果采用补救性带蒂腹直肌皮瓣技术完成自体乳房再造的原因包括穿支距离血管蒂太远18例、血管蒂主干性状不佳5例。皮瓣形式包括两种,15例患者采用单侧补救性带蒂腹直肌皮瓣,皮瓣长度为(21.5±0.8)cm,宽度为(11.2±1.3)cm,所有皮瓣血运良好,不需要额外吻合血管。8例患者采用单侧补救性带蒂腹直肌皮瓣联合对侧游离下腹部皮瓣,皮瓣长度为(29.3±0.7)cm,宽度为(12.0±1.8)cm,所有游离下腹部皮瓣一侧的腹壁下血管蒂与受区胸廓内血管吻合,所有皮瓣全部顺利成活。23例患者皮瓣成活率为100%(23/23),患者满意度为100%(23/23)。再造乳房外形可,质地满意,无皮瓣挛缩变形,与健侧乳房外形基本对称;皮瓣供区及乳房受区仅遗留线性瘢痕,腹壁功能无明显影响。结论在下腹部穿支血管性状不满意的情况下采用补救性带蒂腹直肌皮瓣移植技术可以确保获得乳房再造的满意效果,提高手术安全性。Objective To evaluate the efficacy and safety of remedial pedicled rectus abdominis myocutaneous flap transplantation for breast reconstruction.Methods This retrospective study included 23 female breast cancer patients who underwent autologous breast reconstruction with a remedial pedicled rectus abdominis myocutaneous flap at Hunan Cancer Hospital from June 2022 to June 2023.The patients'ages ranged from 24 to 56 years,with a mean age of(43.2±1.3)years.All patients had previously undergone mastectomy and tumor resection before receiving the remedial pedicled rectus abdominis myocutaneous flap reconstruction.Follow-up was conducted through outpatient visits and telephone interviews,with a median follow-up period of 10(6-15)months.Observation indicators included survival rate of flaps,patient satisfaction rate and aesthetic outcomes.Adverse reactions including but not limited to flap contracture and deformation,during and following the surgical procedure were also recorded.Results The remedial pedicled rectus abdominis myocutaneous flap technique was utilized for autologous breast reconstruction in 23 patients.Specifically,this approach was chosen due to two primary reasons:the perforator distance from the vascular pedicle being excessively long in 18 cases,and suboptimal characteristics of the main pedicle in 5 cases.Two types of flap configurations were employed.For 15 patients,a unilateral remedial pedicled rectus abdominis myocutaneous flap was used,with an average flap size of(21.5±0.8)cm in length and(11.2±1.3)cm in width.All flaps demonstrated adequate blood supply without the need for additional vascular anastomosis.For the remaining 8 patients,a combination of a unilateral remedial pedicled rectus abdominis myocutaneous flap and a contralateral free lower abdominal flap was utilized,resulting in an average flap size of(29.3±0.7)cm in length and(12.0±1.8)cm in width.In these cases,the inferior epigastric vessels of the free lower abdominal flap were successfully anastomosed to the internal thoracic ve

关 键 词：乳腺肿瘤 带蒂腹直肌皮瓣 乳房再造 

分 类 号：R737.9[医药卫生—肿瘤]