游离腹部皮瓣乳房重建术后皮瓣血管危象相关因素分析

Risk factors of vascular complications after free abdominal flap breast reconstruction

目的分析游离腹部皮瓣乳房重建术后皮瓣血管危象发生的相关因素。方法收集2006年11月至2015年2月在复旦大学附属肿瘤医院乳腺外科147例接受游离腹部皮瓣乳房重建的病人资料,分析血管危象的发生和解救情况,并通过统计分析寻找血管危象的相关因素。结果 147例乳房重建中,术后共有12例(8.2%)发生血管危象,其中11例为静脉危象,1例为静脉危象合并动脉危象。最终7例(58.3%)解救成功,2例发生部分坏死,3例全部坏死,总皮瓣成功率为98.0%。手术时间与血管危象的相关度较高(OR=5.696)。结论血管危象的发生受诸多因素的影响,手术时间与其紧密相关,术者经验的积累、血管吻合器的应用等均有助于手术时间的缩短。

Objective To analyze the risk factors of vascular complications after free abdominal flap breastreconstruction.Methods The clinical data of 147 cases of free abdominal flap breast reconstruction performed fromNovember 2006 to February 2015 in Department of Breast Surgery,Fudan University Shanghai Cancer Center wereincluded into the study. Vascular complications and salvages were described. Statistical analysis was conducted toevalute risk factors of vascular complications.Results A total of 12 cases（8.2%） presented with vascular complicationsin 147 cases of breast reconstructions. Among them,11 cases had venous complications,1 had venous coupled byarterial complication. Seven flaps were saved with salvage success rate of 58.3%,2 flaps were lost partially and 3 flapsfailed. The overall flap success rate was 98.0%. Total operation time had a significant relation with vascularcomplications（OR=5.696）.Conclusion Total operation time is closely related to vascular complications. Keeping suchtime to the minimum necessary by improving surgeons’ techniques and using Coupler for venous anastomosis might behelpful to improve flap survival.