Coupler静脉吻合器用于乳腺癌游离腹部皮瓣乳房重建疗效分析

Assessment of the Coupler therapeutic effect for venous anastomosis in abdominal free flap breast reconstruction

目的评估Coupler静脉吻合器用于乳腺癌游离腹部皮瓣乳房重建的安全性及时效性。方法 2012年7月至2013年12月复旦大学附属肿瘤医院共完成45例游离腹部皮瓣乳房重建,根据吻合静脉血管是否使用Coupler吻合器分为两组:手工吻合组(28例)和Coupler组(17例),比较两组重建手术总时间、皮瓣缺血时间、血管吻合时间,以及因皮瓣循环危象需要手术解救的例数和皮瓣存活率。结果在即刻重建病人中,Coupler组手术总时间较手工吻合组短[(7.1±0.3)h vs.(8.6±0.2)h,P<0.05)];所有病人中,Coupler组皮瓣缺血时间明显缩短[(69.3±3.4)min vs.(81.5±3.7)min,P<0.05)];Coupler组血管吻合时间(包括动、静脉吻合时间)也显著缩短[(47.9±3.3)min vs.(68.5±3.8)min,P<0.05)]。皮瓣循环危象发生率手工吻合组为10.7%(3/28),Coupler组为5.9%(1/17),差异无统计学意义(P>0.05);两组各出现1例部分皮瓣坏死。结论在游离皮瓣乳房重建手术中,与传统吻合技术比较,运用Coupler吻合器进行静脉吻合能够显著缩短手术时间,该技术易于掌握且安全可靠。

Objective To analyze free abdominal flap for breast reconstruction with or without Coupler for venous anastomosis, and investigate its safety and effectiveness. Methods From July 2012 to December 2013~45 cases of free abdominal flap breast reconstruction performed in Fudan University Shanghai Cancer Center were enrolled in the study. Patients were divided into two groups （hand-sewn： 28 cases, Coupler： 17cases）. Total surgical time, flap ischemic time, vessels anastomotic time and complications incidence were compared between two groups. Results In immediate reconstruction surgery, Coupler group cost less time for total surgical time [（7.1±0.3）h vs. （8.6±0.2） h,P〈O.01 ）]. For all patients, Couplers could not only save flap ischemic time [（85.7±3.7） min vs. （69.3±3.4）min, P〈0.01）], but also save vessels anastomotic time[（47.9±3.3）min vs. （68.5±3.8）min, P〈O.01）]. The rate of acute mierovessel crisis of flap was 10.7% in hand-sewn group, and 5.9% in Coupler group, without statistical significance （P〉0.05）. One partial flap necrosis occurred in each group, and no total flap loss occurred. Conclusion Comparing with hand-sewn technique, Coupler provides a safe and reliable method in venous anastomosis, easy to handle and could save surgical time significantly.