新辅助治疗后腹壁下深血管穿支皮瓣即刻乳房重建手术的安全性研究

Safety analysis of immediate breast reconstruction with deep inferior epigastric perforator after neoadjuvant treatment

目的:评估新辅助治疗后病人采用腹壁下深血管穿支(deep inferior epigastric perforator,DIEP)皮瓣行即刻乳房重建手术的安全性。方法:收集2019年1月至2021年2月瑞金医院普外科乳腺疾病诊治中心乳腺癌病人,行乳房全切联合DIEP皮瓣即刻乳房重建术的资料。比较新辅助治疗组与对照组病人的临床病理特征。单因素分析比较两组病人的手术并发症发生率。结果:共研究110例,新辅助治疗组23例(20.9%),对照组87例(79.1%)。相比于对照组,新辅助治疗组无原位癌(0比19.5%,P=0.003),pTNM分期较晚(P<0.001)。两组DIEP皮瓣穿支数(P=0.472)、双蒂皮瓣的占比(P=0.489)、手术时间(P=0.651)以及住院时间(P=0.275)差异均无统计学意义。两组术后并发症发生率差异亦无统计学意义。新辅助治疗组最常见的受区并发症为乳房血清肿(13.0%,3例),未见供区并发症。对照组最常见的受区并发症为脂肪坏死(12.6%,11例),最常见的供区并发症为腹部血清肿(3.4%,3例)。新辅助治疗组与对照组分别有1例(4.3%)和4例(4.6%)二次手术。对照组2例(2.3%)发生DIEP皮瓣坏死并丢失,新辅助治疗组未发生。结论:对于新辅助治疗后的乳腺癌病人,行游离腹壁皮瓣即刻乳房重建是安全的手术方案。

Objective To evaluate the safety of immediate breast reconstruction using deep inferior epigastric perfo-rator(DIEP)flaps in the patients after neoadjuvant treatment.Methods From January 2019 to February 2021,the data of patients with breast cancer undergoing total mastectomy and immediate breast reconstruction using DIEP flap in Compre-hensive Breast Health Center,Department of General Surgery,Ruijin Hospital were collected.Comparison of clinicopatho-logical features was done between neoadjuvant treatment group and control group.Univariate analysis was used to compare the rate of surgical complications between two groups.Results A total of 110 patients were enrolled with 23 cases(20.9%)in neoadjuvant treatment group and 87 cases(79.1%)in control group.None of carcinoma in situ(0 vs.19.5%,P=0.003)and higher pTNM stage(P<0.001)was present in neoadjuvant treatment group compared with those in control group.However,there were no significant differences in the number of flap perforator of DIEP(P=0.472),the proportion of bipedicled flaps(P=0.489),operative time(P=0.651)and hospital length of stay(P=0.275)between two groups.No significant difference was found in the incidence of postoperative complications between two groups.Breast seroma was the most common recipient complication(13.0%,3 cases)without donor complication in neoadjuvant treatment group.The most common complication was fat necrosis(12.6%,11 cases)in recipient site and abdominal seroma(3.4%,3 cases)in donor site of control group.Reoperation was done in one case(4.3%)of neoadjuvant treatment group and 4 cases(4.6%)of control group.DIEP flap necrosis with total flap loss occurred in 2 cases(2.3%)in control group,but none in neoadjuvant treatment group.Conclusions The immediate breast reconstruction with epigastric free flap for breast cancer patients after neoadjuvant treatment would be a safe surgical scheme.