游离皮瓣在乳腺重建术患者中的的应用

Application of Free Flap in Patients Undergoing Breast Reconstruction

【目的】探讨应用游离皮瓣对乳腺癌手术患者进行乳房重建的应用方法及疗效。【方法】收集本科2008年1月至2011年1月间住院的40例乳腺癌手术患者，随机分为研究组和对照组，研究组应用腹壁下动脉穿支游离皮瓣进行乳房重建，对照组给予转移下腹部横行腹直肌肌皮瓣进行乳房重建，对比两组手术的疗效。【结果】研究组重建的乳房未见明显萎缩，质地柔软，色泽外形接近正常乳房，腹部供区恢复良好未见腹壁薄弱的现象发生。研究组手术时间为（6．1±0．7）h，术后住院时间平均为（7．2±1．1）d与对照组（5．9±1．9，14．7±2．3）比较无显著差异（ P＞0．05），未见术后腹部供区的皮下积血等腹部并发症的发生，与对照组比较具有显著差异（ P ＜0．05）。【结论】应用腹壁下动脉穿支游离皮瓣进行乳房重建效果确切，减少了腹部并发症发生的机率同时不影响肿瘤的治疗，达到患者对于胸部塑形的要求，值得在临床上推广应用。

[Objective] To explore the application methods and efficacy of free flap in breast reconstruction for patients undergoing breast cancer operation .[Methods]A total of 40 inpatients undergoing breast cancer operation in our department from Jan .2009 to Jan .2011 were randomly divided into study group and control group .The study group underwent breast reconstruction by using inferior epigastric perforating artery free flap ,while the control group underwent breast reconstruction by using transferred lower abdominal transverse rectus abdominis myocutaneous flap .The efficacy was compared between two groups .[Results]The recon-structed breasts in the study group showed no obvious atrophy ,and had soft texture ,and the color and shape were close to normal breasts .Abdominal donor sites recovered well ,and no abdominal weak phenomenon oc-curred .The operation time of the study group was 6 .1 ± 0 .7h ,and postoperative average hospitalization time was 7 .2 ± 1 .1d ,and there was no significant difference between the study group and control group （ P 〉0 .05） .No postoperative abdominal complications such as subcutaneous hematocele in abdominal donor sites occurred in the study group ,and there was significant difference between the study group and control group （ P〈0 .05） .[Conclusion] The inferior epigastric perforating artery free flap for breast reconstruction has certain efficacy ,and can reduce the probability of abdominal complications and not affect the treatment of the tumors , and achieve the requirement for chest shaping .Therefore it is worthy of clinical promotion .