乳房再造术中胸廓内动脉远、近心断端血液动力学研究及远期观察

Clinical study of the hemodynamics of both ends (proximal and distal) of internal mammary artery and its following-up

目的 评价胸廓内动脉远心端 (逆向 )供血的功能 ,为乳房再造及胸壁修复提供新的血供来源。方法 对 2例应用双侧腹壁下动、静脉为蒂的横形腹直肌肌皮瓣 (Transverserectusabdom inalmyocutaneousflap下简称TRAM皮瓣 )吻合血管游离移植行乳房再造患者 ,于术中对作为胸部受区血管的胸廓内动脉远心断端、近心断端 (下简称远心端、近心端 )的压力流速进行测量 ,并对TRAM在相应不同供血状态的微循环灌注情况进行监测 ,对 1例术后 5年患者行彩色多普勒仪追踪检测。结果 术时胸廓内动脉远心端压力为 6 6及 5 8mmHg ,近心端压力为 88及 75mmHg,远心端压力为近心端压力的 75 %～ 77% ,两者的波形不同。胸廓内动脉远心端吻合口流速为 70及 5 2ml min ,近心端为 94及 74ml min ,远心端流速为近心端流速的 74 %～ 78%。以双侧腹壁下动、静脉为蒂的TRAM在胸廓内动脉远心端、近心端同时供血状态下 ,其皮瓣灌注值最高。术后 5年 ,远、近心端吻合口仍通畅良好 ,两处动脉血流的频谱、流速几乎相同。结论 胸廓内动脉远心端可以提供一定压力的血供 。

Objective\ To verify the value of retrograde flow of Internal Mammary Artery (IMA) used as one of the supplying arteries and to develop a new method of applying IMA in breast reconstruction. Methods\ During breast reconstruction with free bilateral transverse rectus abdominis myocutaneous (TRAM) flap, the pressures and velocities of the two ends (proximal and distal) of internal mammary artery as well as the according perfusion unit (PU) of TRAM were measured in two patients who suffered from mammectomy because of carcinoma. Results\ The pressure at distal end was 66 or/and 58 mmHg, the pressure at proximal end was 88 or/and 75 mmHg, the former is 75%～77% of the later. The immediate rate of blood flow of distal anastomotic stoma was 74 or/and 52 ml/min, that of proximal was 94 or/and 70 ml/min, the former is 74%～78% of the later after anastomosed to the two sides of deep inferior epigastric arteries (DIEA) separately. Under condition that both ends (proximal and distal) of IMA contributing as the supplying blood vessels simultaneously, the PU of TRAM was the best. The rates of blood flow at the two anastomotic stomas are similar to each other in late stage (evaluated at the fifth year follow up). Conclusion\ The distal end of internal mammary artery can supply blood flow in a considerable level, similar with the proximal end.\;