吻合血管的腹部皮瓣在乳腺肿瘤切除术后乳房整形中的应用

Application of abdominal flap with vascular anastomosis in breast oncoplastic surgery

目的探讨吻合血管的腹部皮瓣在乳腺肿瘤切除术后乳房整形中的应用效果。方法回顾性分析自2014年3月至2016年3月,60例乳腺肿瘤患者应用腹部皮瓣行一期乳房重建或乳腺癌术后创面修复,术中进行不同数量的血管吻合。结果应用吻合血管的腹部皮瓣行一期乳房重建50例;乳腺肿瘤术后创面修复10例。其中带蒂横行腹直肌皮瓣(TRAM)+腹壁浅静脉(SIEV)吻合10例;单蒂腹壁下动脉穿支皮瓣(DIEP)40例;TRAM+对侧DIEP皮瓣8例;双蒂DIEP皮瓣2例。术后出现血管危象2例,切口感染2例,皮瓣Ⅳ区部分坏死2例,腹部膨隆2例,皮下血肿1例,皮瓣下脂肪液化1例,供区脂肪液化1例,脐坏死1例,无腹壁疝等并发症发生。57例患者术后获随访6~29个月,远处转移2例,局部复发1例。乳房重建患者总体满意度较高,局部晚期患者术后创面及时修复,生活质量明显提高。结论采用多种形式吻合血管的腹部皮瓣行乳房重建或创面修复,血供可靠,临床效果较满意。

Objective To explore the application of an abdominal flap with vascular anastomosis in breast oncoplastic surgery. Methods From March 2014 to March 2016, the cases of 60 breast cancer patients were retrospectively analyzed. All cases underwent one-stage breast reconstruction by abdominal flaps or wound healing after tumor excision. Different numbers of vascular anastomosis were performed intraoperatively. Results Fifty cases underwent one-stage breast reconstruction and 10 eases under went wound healing by abdominal flaps with vascular anastomosis after tumor excision. Among them, 10 cases underwent pedicled TRAM flap＋SIEV anastomosed, 40 cases underwent DIEP flap, 8 cases underwent pedicled TRAM ＋ contralateral DIEP flap, antl 2 cases underwent double pedicie DIEP flap. There were 2 cases of vascular crisis, 2 cases of incision infection, 2 cases of partial necrosis of the Zone IV flap, 2 cases of abdominal distention, 1 case of hematoma, 1 case of fat liquefaction under the flap, 1 case of donor fat liquefaction, and 1 case of umbilical necrosis, postoperative. No abdominal hernia or other complications occulted. During the follow-up from 6 to 29 months, there were 2 cases of distant metastasis, 1 case of local recurrence and 3 cases were lost to follow-up. The overall satisfaction of the patients with mammary reconstruction was high, and quality of life was significantly improved. The postoperative wounds were repaired in a timely manner. Conclusions The ap- plication of abdominal flaps with vascular anastomosis for breast reconstruction or wound healing can achieve reliable blood supply and satisfactory clinical results.