腹壁下深血管穿支皮瓣的监测与解救策略

Strategies and methods of monitoring and rescue of DIEP flap in breast reconstruction

自体组织乳房重建在即刻和延期重建中占据一定的比例,游离腹壁下深血管穿支皮瓣(deep inferior epigastric perforator,DIEP)具备显著的优势,逐渐在国内得到广泛推广应用。DIEP的手术成功率一般在95%以上,但不可避免可能会发生血管危象和坏死。手术前应做好人员、器械的准备,对患者进行完善的评估。手术过程中,要遵循一定的程序性和规范化,通过精细的操作,尽力降低血管危象的发生风险。术中和术后,建立皮瓣监测的标准流程,并加以严格执行;发生血管危象时,应及时、有序地组织、实施探查和解救,发现并尽可能挽救皮瓣,保障患者整体安全,减少对后续肿瘤辅助治疗的干扰。本文结合长期、大量的临床工作经验,分享、探讨乳腺癌重建手术中游离皮瓣的监测和解救的策略与方法。

Autologous tissue reconstruction accounts for a certain proportion in immediate or delayed breast reconstruction.Deep infra-epigastric perforator free flap has its significant advantages,gradually being widely promoted and applied in China.The success rate of DIEP surgery is generally over 95%.However,vessel crisis and flap necrosis are inevitable.Before surgery,personnel and equipment should be prepared and patients should be thoroughly evaluated.During the surgical process,it is necessary to follow certain programmed and standardized procedures.Meticulous manipulations through entire operation are the key to reduce the risk of vessel crisis.Standard of procedure for flap monitoring during and after surgery should be established,and strictly implemented.If vessel crisis occurs,timely and orderly organization,exploration,and rescue should be carried out.The surgical team should do their best to identify problems,and rescue the flap as much as possible.Ensuring the overall safety and reducing interference with subsequent adjuvant treatment for patients should be considered.Based on the author’s long-term and extensive clinical work experience,this paper shares and discusses the strategies and methods of monitoring and rescue of free flap in breast reconstruction.