乳房再造和胸壁修复同时应用血管化的淋巴移植修复治疗乳腺癌术后上肢淋巴水肿

Breast reconstruction and treatment of mastectomy related upper limb lymphedema with lymphatic TRAM/DIEP

目的探讨腹部皮瓣携带血管化淋巴游离移植的要点,评价乳腺癌术后胸壁修复、乳房再造同时行淋巴移植治疗上肢淋巴水肿的手术效果。方法对2008年1月至2011年3月收治的10例乳腺癌术后上肢淋巴水肿的患者进行回顾性分析。所有患者均为单侧上肢淋巴水肿。在乳腺癌术后行胸壁修复、乳房再造的同时采用腹部皮瓣携带血管化淋巴游离移植治疗上肢淋巴水肿。结果所有患者的皮瓣成活良好,1例患者出现了胸壁切口延迟愈合。所有患者均自觉患肢疼痛及肿胀程度缓解。结论应用腹部皮瓣携带血管化淋巴游离移植行乳腺癌术后胸壁修复、乳房再造的同时治疗上肢淋巴水肿,术后配合弹力绷带等辅助治疗,是对乳腺癌术后乳房形态及上肢功能双重修复的有效方法。

Objective To introduce the key points about the transplantation of lymphatic transverse rectus abdominis myocutaneous/deep inferior epigastric perforator（TRAM/DIEP） and evaluate the therapeutic effect of lymphatic TRAM/DIEP to treat mastectomy related upper limb lymphedema. Methods Ten patients of postoperative lymphedema after breast cancer surgery from Jan. 2008 to Mar. 2011 were enrolled in this study. All the patients suffered from unilateral upper-limb lymphedema accepted abdominal transplantation of lymphatic TRAM/DIEP. Results All flaps worked well. One case with breast reconstruction was found to have delayed cure of breast cuts. All the patients felt the pain and swellings of edematous upper limbs relieved. Conclusion To apply the transplantation of lymphatic TRAM/DIEP to treat mastectomy related upper limb lymphedema, accompanied by using elastic bandages as an auxiliary post-operative treatment is considered to be an effective method to restore the breast configuration and upper limb function.