腹壁浅静脉超回流在单蒂腹壁下动脉穿支皮瓣乳房再造中的作用

The role of superdrainage using superficial inferior epigastric vein in single-pedicled deep inferior epigastric perforator flap breast reconstruction

目的探究在延期单蒂腹壁下动脉穿支(DIEP)皮瓣乳房再造中预防性使用腹壁浅静脉(SIEV)进行静脉超回流的安全性和有效性。方法回顾性分析2018年5月至2022年8月在中国医学科学院整形外科医院乳腺综合整形科行单蒂DIEP皮瓣延期单侧乳房再造患者的临床资料,按是否行SIEV-胸廓内静脉远心端吻合分为超回流组和非超回流组。记录SIEV的直径、吻合所需时间,比较2组的手术总时间、皮瓣缺血时间、住院时间、皮瓣弥漫性淤血率、受区和供区并发症发生率、二次手术率,计算未进行超回流时皮瓣弥漫性淤血、并发症和二次手术的相对危险度。采用SPSS 24.0软件进行数据分析,计量资料以±s表示,组间比较采用独立样本t检验;计数资料用%表示,组间比较采用χ^(2)检验,P<0.05为差异有统计学意义。结果共纳入患者45例,非超回流组26例,超回流组19例,手术总时间分别为(7.7±1.9)、(8.4±1.5)h,皮瓣缺血时间分别为(89.5±10.4)、(92.6±12.3)min,住院时间分别为(6.6±1.8)、(6.6±2.0)d,差异均无统计学意义(P>0.05)。超回流组SIEV直径为(2.5±0.3)mm,均采用手工缝合,吻合1根SIEV所需时间为(12.2±2.3)min。皮瓣弥漫性淤血、受区并发症、供区并发症、二次手术的发生率在非超回流组分别为7.7%(2/26)、15.4%(4/26)、7.7%(2/26)和15.4%(4/26),超回流组分别为0(0/19)、5.3%(1/19)、10.5%(2/19)和5.3%(1/19),2组比较差异均无统计学意义(P>0.05);未进行超回流时上述4个指标的相对危险度分别为3.7、2.9、0.7和2.9。结论预防性使用SIEV瓣外超回流的安全性和有效性较高,不增加皮瓣缺血时间和腹部并发症,同时可将潜在的皮瓣弥漫性静脉淤血和二次手术率降到最低。

Objective To explore the safety and efficacy of prophylactic superdrainage using superficial inferior epigastric vein(SIEV)in delayed single-pedicled deep inferior epigastric perforator(DIEP)flap breast reconstruction.Methods The clinical data of all patients who underwent single-pedicle DIEP flap delayed breast reconstruction in Department of Comprehensive Breast Plasty Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from May 2018 to August 2022 were retrospectively analyzed.According to whether SIEV-internal thoracic vein anastomosis was performed,they were divided into superdrainaged group and non-superdrainaged group.The diameter of SIEV and the time required for anastomosis were recorded.The total operation time,flap ischemia time,hospital stay,the rates of flap diffuse congestion,overall complications and second operation were compared between the two groups.The relative risks of flap diffuse congestion,complications and second operation were calculated.SPSS 24.0 software was used for data analysis.Measurement data was expressed as Mean±SD,independent sample t test was used for analysis.Counting data was expressed as%,andχ2 test was used for analysis.P<0.05 was considered statistically significant.Results A total of 45 patients were included,including 26 patients in the non-superdrainaged group and 19 patients in the superdrainaged group.The total operation time was(7.7±1.9)h and(8.4±1.5)h,the flap ischemia time was(89.5±10.4)min and(92.6±12.3)min,and the hospital stay was(6.6±1.8)d and(6.6±2.0)d,respectively.There were no significant differences(P>0.05).In the superdrainaged group,the diameter of SIEV was(2.5±0.3)mm,and manual suture was used.The time required for anastomosis of one SIEV was(12.2±2.3)min.The rates of diffuse congestion,recipient site complications,donor site complications and second operation were 7.7%(2/26),15.4%(4/26),7.7%(2/26)and 15.4%(4/26)in the non-superdrainaged group,and 0(0/19),5.3%(1/19),10.5%(2/19)and 5.3%(1/19)in the superdrainaged group,respectively.There were no significant differences between the two groups(P>0.05).The relative risks were 3.7,2.9,0.7 and 2.9,respectively.Conclusion Prophylactic superdrainage using SIEV is safe and effective.It can minimize the potential rate of diffuse venous congestion and secondary surgery,and not at the expense of increased flap ischemia time and abdominal complications in the meanwhile.