腹壁下深血管穿支皮瓣在乳房重建应用中的技术难点与要点

Technical difficulties and key points of DIEP in breast reconstruction

乳腺癌的外科手术是综合治疗的重要组成部分,乳房缺失会给患者带来严重的心理创伤,极大地降低生活质量。自体组织乳房重建中,以腹壁下深血管穿支皮瓣(deep inferior epigastric perforator flap,DIEP)为代表的重建技术有着不可比拟的优势,组织血供充足,重建乳房轮廓、质地自然,供区并发症低;也是其他重建失败后的重要替代方案。但DIEP手术难度大,学习曲线长,其技术要点和难点不仅贯穿于手术全程,也存在于手术前后。在深刻理解DIEP的主要概念的基础上,用图文并茂的方式详细阐述手术过程中的重要细节,强调术后皮瓣监测及其应对预案,有助于更好地推广该手术技术,提高手术成功率和患者满意度,降低手术并发症,造福更多的乳腺癌患者。

Surgical treatment is an important part of comprehensive management for breast cancer patients.Loss of breast will bring serious psychological trauma to patients and greatly reduce the quality of life.In autologous breast reconstruction,deep inferior epigastric artery perforator flap(DIEP)-a representative reconstructive technology has its incomparable advantages.The flap has sufficient blood supply.The reconstructed breast has natural contour and texture,and the complications in the donor area were quite low.It is also an important alternative to rescue the reconstructive failures.However,DIEP flap is difficult and has a long learning curve.The key technical points and difficulties not only run through the whole process of operation,but also exist before and after operation.On the basis of mastering the main concepts of DIEP,this paper would elaborate the important details in the operation process and emphasize the monitoring of skin flap after operation and the corresponding plan.This will help to better popularize the operation technique,improve the success rate of operation and patient satisfaction,while reduce operative complications and benefit more breast cancer patients.