女性乳房手术预防乳头乳晕坏死的血供研究

A study of the blood supply relevant to prevention of nipple-areola necrosis in female breast operation

目的研究女性乳头乳晕的动脉血供特点,为乳腺手术时避免乳头乳晕坏死提供解剖依据。方法对13具女性尸体26个乳房标本的乳头乳晕血管进行解剖学观察。结果乳头乳晕动脉血供主要由胸外侧动脉分支及胸廓内动脉穿支供应胸廓内动脉第2～4肋间血管穿支与胸外侧动脉的乳头乳晕支分别从乳晕上、内方和外上方经腺体小叶之间到达乳头乳晕基底部,然后在乳腺导管间上行供应乳头乳晕;胸廓内动脉肋间穿支和胸外侧动脉分支的浅层腺体穿支在皮下形成广泛吻合,特别是在乳晕下形成动脉网,由此网发出分支供应乳头乳晕;肋间动脉穿支与胸肩峰动脉未见有分支供应乳头乳晕。结论保留乳头的乳腺癌根治术时,为了避免乳头乳晕坏死,应注意保护乳晕下动脉网,这时的皮瓣厚度不能小于0.5cm。乳房缩小整形术时,应以乳房内上或外上象限腺体作为腺蒂,并且注意保留乳腺后方至少1.5cm厚的腺体,以保证胸廓内动脉第2～4肋间穿支或胸外侧动脉乳头乳晕支对乳头乳晕的血液供应。

Objective To study the arterial blood supply of nipple-areola and provide the anatomical basis for avoiding nipple-areola necrosis in breast operation. Methods The vascular structure of nipple-areola of 26 female breasts in 13 cadavers were studied. Results The nipple-areola mainly accepted arterial blood supply from branches of the lateral thoracic artery and the internal thoracic artery. The 2nd^4th intercostal ~perforating branches of the internal thoracic artery and branches of the lateral thoracic artery reach the base of nipple-areola from a superior,medial and upper lateral direction by passing between lobules of mammary gland, then ascend between the lacteal ducts to supply the nipple-areola; the perforators of the lateral thoracic artery and the superticial breast perforators of internal thoracic artery, formed extensive anastomoses ~subcutaneously , and particulatly under areola formed arterial rete, from which branches were given out to ~nipple-areola . The intercostal perforators and thoracoacromial perforators did not supply the nipple-areola. Conclusions When nipple-sparing mastectomy is performed, in order to avoid nipple-areola necrosis,it is necessary to protect the arterial rete under the areola, and thus, the thickness of areolar skin flap should not be less than 0.5cm; to ensure the blood supply of nipple-areola from the internal thoracic artery and the ~lateral thoracic artery in breast reduction, the superior-medial or superior-lateral breast pedicle should be used and the thickness of preserved posterior breast should not be less than 1.5cm.