游离腹壁下动脉穿支皮瓣在乳房再造中的应用

Application of the deep inferior epigastric perforator flap in breast reconstruction

目的:探讨游离腹壁下动脉皮肤穿支(deep inferior epigastric perforator,DIEP)皮瓣在早期乳腺癌患者(Ⅰ或Ⅱ期)术后乳房再造中的临床应用。方法:对12例早期乳腺癌患者行根治术或改良根治术同期或二期应用DIEP皮瓣行乳房再造,其中乳腺癌分期I期9例,II期3例。结果:1例皮瓣出现部分坏死,1例皮瓣出现脂肪液化,经换药后愈合,其余皮瓣均成活,再造乳房外形可,弹性好,无皮瓣挛缩变形;无腹壁疝和腹壁膨出。11例获随访平均2.2年,效果均较满意,未出现乳腺癌复发病例,4例获得优,5例获得良,失访1例按良计算,2例效果差,优良率83.3%。结论:乳腺癌术后一期或二期应用DIEP皮瓣游离移植再造乳房,具有皮瓣血运良好、再造乳房外形满意、腹部供区并发症少,可同时行腹壁整形等优点,是乳腺癌术后乳房再造的理想方法之一,放化疗不影响皮瓣的成活。

Objective To study the appliction of the free abdominal artery perforators flaps in breast reconstruction in patients with early breast cancer （ I or Ⅱ ）. Methods 12 cases of early breast cancer patients with radical or modified radical surgery. The DIEP flap was used to reconstruct breast at the same time or in the second phase. 9 cases of breast cancer were in stage I and 3 cases was in stage Ⅱ. Results The flap was necrosis in 1 patient. 1 case appeared fat liquefaction and the wound healed after revamping. The rest survived without serious comlications. The reconstructive breast＇s shape, elasticity was good,and no flap contracture deformation happened.11 cases received follow-up and an average of 2.2 years.The effect is satisfactory,and no recurrence ofbreast cancer cases.4 cases were excellent,5 cases were good and 1 lost casewas scored as good. The rate was 83.3%. Conclusion The postoperative application of free DIEP flap in reconstructed breasts was suit for breast cancer patients.The blood supply and good reconstructive breast shape with flap, abdominal area for fewer complications,at the same time line of the abdominal wall advantages,such as plastic is one of ideal methods of breast reconstruction after breast cancer.