腹壁下动脉解剖学及乳腺癌术后TRAM皮瓣再造

Experimental study on the clinical application of breast reconstruction with the flap supplied by inferior epigastric artery

目的:解剖腹壁下动脉全长,观察其走行及与腹直肌的位置关系,并利用超声检查了解腹壁下动脉的相关解剖学参数,探讨超声学检查在临床乳房再造中的辅助意义,为开展乳腺癌术后乳房重建提供基础资料。方法:5例经体积分数为10%甲醛溶液固定的中国成年女性尸体标本,自腹壁下动脉起点处灌注医用红色乳胶后解剖其全长,观察并记录动脉走行、分支及供应范围;利用彩色多普勒超声诊断仪检查健康成年女性腹壁下动脉,观察其分支数目,测量起始处外径及血流参数,并对以上所得数据进行统计学处理。结果:尸体标本中腹壁下动脉主干平均全长(8.28±0.27)cm,自髂外动脉起点处外径均值(2.35±0.14)mm,该处距腹股沟深环均值(1.13±0.22)cm,浅环均值(3.75±0.41)cm,供应组织面积为均值(153.40±23.25)cm2;沿途发出数目不等的穿支(7-18),平均(12.3±2.83)支,腹壁下动脉皮下穿支外径为均值(1.56±0.12)mm。结论:腹壁下动脉管径及分支数目较为恒定,血流丰富,其超声检查简便、无创,可提供可靠的解剖学信息,临床应用腹直肌肌皮瓣或腹壁下动脉穿支皮瓣进行乳房再造是安全可行的,需注意术中仔细操作。

Aim：To dissect the full-length of inferior epigastric artery,and observe its route and the location relationship with rectus abdominis.Understand the parameters of inferior epigastric artery related to its anatomy with ultrasound,and to explore the auxiliary significance of ultrasound in the use of clinical breast reconstruction,and to provide the basic information for the breast reconstruction after surgery of breast cancer.Methods： Five Chinese adult female cadavers fixed with 10% formalin,injecte medical red latex into the starting point of inferior epigastric artery.Dissect the full-length of this artery,and then watch and record its route,branches and scope of supply.Check up the inferior epigastric artery of healthy adult female with color doppler ultrasonoscope,observe the number of its branch,measure the diameter and the blood flow parameters at the point of starting.Give statistical analysis of all the data at last.Results： The average full-length of inferior epigastric artery of cadavers is（8.28±0.27）cm.The external diameter at the starting point of external iliac artery is（2.35±0.14）mm,and the distance from here to deep inguinal ring is（1.13±0.22）cm,to superficial inguinal ring is（3.75±0.41）cm,and the area supply by the artery is（153.40±23.25）cm2.The number of branches issued by inferior epigastric artery is from 7 to 18,and the average number is（12.3±2.83）.The external diameter of Deep inferior epigastric perforator is（1.56±0.12）mm.Conclusion：The external diameter of inferior epigastric artery and the number of its branches is constant,and the supply of blood is very rich.As a simple and no-invasive examination pattern,ultrasound can provide reliable anatomical information.It is safe and feasible for breast reconstruction with Transverse rectus abdominis musculocutaneous（TRAM） flap or deep inferior epigastric perforator（DIEP） flap in clinical,and careful operation is needed during surgery.