筋膜组织在假体乳房重建中的应用

Utility of fascia in implant-based breast reconstruction

目的总结可在假体乳房重建术(IBBR)中充当覆盖物的自体筋膜类型及其手术应用。方法以"筋膜""软组织""乳房重建""乳房再造""假体""植入物""安全性""并发症"和"fascia""soft tissue""breast reconstruction""implant""prosthesis""outcome""complication"等中、英文关键词,在中国知网、万方数据库、PubMed、Web of Science数据库中检索2021年3月之前发表的筋膜组织在假体乳房重建中应用的相关文献385篇,通过阅读文章标题与摘要,剔除与研究方向不符、内容重复、无法获取全文的文献,最终纳入25篇文献。总结和分析不同类型的筋膜在IBBR中的手术应用。结果目前常被作为IBBR覆盖物的筋膜有前锯肌筋膜、胸大肌筋膜、上腹部筋膜及由这些筋膜构成的融合筋膜。这些筋膜组织可单独或联合补片用于IBBR。筋膜组织具有分离方便、操作简单、费用少等优点,与传统假体覆盖物(肌肉组织及补片)有相似的外科学安全性。但在乳腺癌患者中,保留筋膜组织仍存在肿瘤学安全性的争议。结论筋膜组织可作为肌肉或补片替代物用于IBBR。筋膜法乳房重建术后并发症发生率不高,重建效果稳定,适合在无法获取补片或开展自体组织乳房重建的基层医院推广使用。

Objective To summarize the kind of fascial flaps used in implant-based breast reconstruction(IBBR)and their surgical procedures.Methods"筋膜""软组织""乳房重建""乳房再造""假体""植入物""安全性""并发症"and"fascia""soft tissue""breast reconstruction""implant""prosthesis""outcome""complication"were used as key words for identifying articles about the utility of fascia in IBBR and with publication date before March 2021 in CNKI,the Wanfang database,Web of Science,and PubMed.A total of 385 articles were identified,of which 25 were finally included after excluding nonconforming articles as to the content,repeated studies,studies with design defects,and articles without available full texts.Results The fascial flaps used in IBBR include serratus anterior fascia,pectoral major fascia,upper abdominal fascia,and conjoined fascia of these fascial flaps.The fascial flaps could be used independently or with meshes in IBBR,are ready-for-use,easy-to-learn,and have low cost.Moreover,the fascial flaps also have comparable surgical safety as conventional implant coverages such as muscular tissues or meshes.In patients with breast cancer,however,the oncological safety of using fascia in IBBR is still controversial.Conclusion Using fascia flaps as alternatives for muscular tissue or meshes in IBBR is feasible.This technology has an acceptable complication rate and reliable outcomes of reconstruction and suitable for hospitals without access to meshes or unable to perform autologous breast reconstruction.