腹壁浅动脉皮瓣行乳房再造的术前评估、术式选择及术后危象研究进展

Research Progress in Preoperative Evaluation,Surgical Approach Selection and Postoperative Crisis for Breast Reconstruction with Superficial Inferior Epigastric Artery Flap

横行腹直肌皮瓣及腹壁下动脉穿支皮瓣(DIEP)作为目前乳房再造的常用术式,均无法避免对腹直肌及其前鞘的完整性造成破坏,因此常导致术后腹壁不对称、疼痛、疝气等并发症的发生。而腹壁浅动脉(SIEA)皮瓣由于在手术过程中不侵及腹部的深层组织结构,可达到满意的再造效果,同时最大限度地降低了上述供区并发症的发生率。应用SIEA皮瓣行乳房再造时,皮瓣血管蒂的管径、长度等解剖学特征,以及术中受区血管的选择、手术方式的差异都可能会影响再造的结局。此外,术后血管危象的预防、监测及处理手段等方面的深入认识同样至关重要。

As common surgical methods of breast reconstruction,the transverse rectus abdominis musculocutaneous( TRAM) flap and the deep inferior epigastric perforator( DIEP) flap both cannot avoid damage to the integrity of the rectus abdominis muscle and its anterior fascia,which leads to the abdominal wall asymmetry,pain,hernia and other complications. The superficial inferior epigastric artery( SIEA) flap does not invade deep tissues of the abdomen,enabling satisfactory reconstructive results and minimizing the incidence of donor complications at the same time. When applying the SIEA flaps for breast reconstruction,factors including the diameter and length of the pedicle,the choice of the recipient area,and surgical methods all might influence the final outcome of the reconstruction. Moreover,further understanding of the prevention,monitoring,and treatment of the postoperative vascular crisis is also imperative.