选择内乳动脉穿支作为受区血管的腹壁下动脉穿支皮瓣乳房再造18例

Internal mammary artery perforators as recipient vessels in breast reconstruction with deep inferior epigastric perforator flap:a report of 18 cases

目的探讨选择内乳动脉穿支(IMAP)作为受区血管在乳腺癌术后即刻用腹壁下动脉穿支皮瓣(DIEPF)进行乳房再造的临床应用效果。方法2020年5月-2023年5月,在河南省肿瘤医院乳腺科接受DIEPF乳房再造的病例中选择IMAP作为受区血管的18例,年龄31~50岁,平均41.5岁。乳腺癌分期为cT_(is/1-2)N_(0-2)M_(0),均为I期乳房再造。皮瓣切取面积9.0 cm×26.0 cm~15.0 cm×38.0 cm,术前行胸腹壁CTA造影,确定IMAP在肋间隙的位置以及粗细。术中记录IMAP的数量,测量受区相应的动、静脉管径。患者出院后通过门诊或微信定期随访,观察皮瓣成活质量,采用乳腺癌患者报告结局量表(BREAST-Q)对乳房外形及供区恢复情况进行评分。结果18例患者,根据CTA提示,术中均发现IMAP,第2肋间13例,第3肋间3例,另外2例在第2、3肋间隙均有IMAP,其中的1例2条分支均适合吻合。15例患者动脉的伴行静脉为1条,2例伴行静脉为2条,1例缺少伴行静脉。动脉管径为(1.1±0.1)mm,静脉管径为(1.8±0.3)mm。随访时间6~40个月,平均28个月。18例皮瓣,17例完全成活,1例皮瓣出现静脉危象,探查发现静脉广泛栓塞,采取假体置入补救。18例患者的患侧内乳区均无凹陷畸形。17例患者BREAST-Q评分平均为94.4分,1例BREAST-Q评分为79.0分。结论IMAP可作为DIEPF乳腺癌术后即刻乳房再造的可靠受区血管,在严格的筛选条件下,值得推广应用。

ObjectiveTo investigate the clinical application effect of internal mammary artery perforator(IMAP)as recipient vessels in breast reconstruction with deep inferior epigastric perforator flap(DIEPF)immediately after breast cancer surgery.MethodsFrom May 2020 to May 2023,a total of 18 patients with DIEPF breast reconstruction using IMAP as recipient vessels were selected from the Department of Breast Disease of Henan Cancer Hospital.The patients were 31 to 50 years old,with an average of 41.5 years old.The stages of breast cancer were cT_(is/1-2)N_(0-2)M_(0),and all of the patients received immediate breast reconstruction after the breast cancer surgery.The size of flaps were from 9.0 cm×26.0 cm to 15.0 cm×38.0 cm.Preoperative chest and abdominal wall CTA were performed to identify the location of intercostal space and the calibre of IMAP.Intraoperatively,the number of IMAP,the diameters of corresponding arteries and accompanying veins in the recipient site were recorded.All patients were included in the scheduled postoperative follow-up through outpatient clinic or via WeChat.The quality of flap survival was evaluated,the condition of breast appearance and recovery of the abdominal donor site were evaluated according to the breast cancer patient reported outcome measures(BREAST-Q).ResultsAll the 18 patients had the IMAP visualised in surgery,with 13 had the IMAP located at the second intercostal space and 3 at the third intercostal space.The other 2 patients were found with the IMAP located in both the second and third intercostal spaces,in which 1 was found that both of IMAP were suitable for anastomosis.It was also found that there was 1 accompanying vein in 15 breasts and 2 accompanying veins in 2 breasts.One breast had found without an accompanying vein.The diameters of arteries were 1.1 mm±0.1 mm and that of the veins were 1.8 mm±0.3 mm.The average follow-up period was 28 months,ranged from 6 to 40 months.Of the 18 flaps,17 were completely survived.Venous compromise occurred in 1 flap due to extensive venous thrombosis,and it was replaced with a breast implant.No patient experienced concave deformities in the reconstructed breasts.Seventeen patients with an average BREAST-Q score of 94.4.One patient with a BREAST-Q score of 79.0.ConclusionIMAP can serve as a reliable recipient vessel for immediate breast reconstruction with DIEPF after breast cancer surgery.With strict selection criteria,this technique could be put on further trials with larger sample size and multi-centres.