乳腺癌术后Ⅰ期乳房重建中游离腹部皮瓣成活率及其风险因素分析

Survival Rate and Risk Factors of Free Abdominal Flap in StageⅠBreast Reconstruction After Breast Cancer Surgery

目的分析乳腺癌术后Ⅰ期乳房重建中游离腹部皮瓣成活率及其风险因素。方法回顾性分析许昌医院普外科于2021年1月至2022年6月完成乳腺癌改良根治术,并于术后接受游离腹部皮瓣Ⅰ期乳房重建术治疗的62例乳腺癌患者资料。患者术后均接受皮瓣穿支血管异常情况检查,根据皮瓣成活情况进行分组,血管发生异常导致皮瓣坏死纳入坏死组,血管状态正常,皮瓣成活纳入成活组,计算皮瓣成活率。分析患者资料、主要临床指标,重点分析乳腺癌术后Ⅰ期乳房重建中游离腹部皮瓣成活率的风险因素。结果62例乳腺癌患者重建术后皮瓣坏死10例,坏死率为16.13%。经logistic回归分析结果显示,体重指数(BMI)>28 kg·m^(-2)、手术时间>8 h、缺血时间>1.5 h、血管吻合时间>1 h、皮瓣血供不良为Ⅰ期乳房重建中游离腹部皮瓣成活的风险因素(OR>1,P<0.05)。结论乳腺癌术后Ⅰ期乳房重建中游离腹部皮瓣成活率较高,但仍有一定坏死风险,可能受患者BMI、手术时间、缺血时间、血管吻合时间、皮瓣血供等因素影响,应引起临床重视。

Objective To analyze the survival rate and risk factors of free abdominal flap in stageⅠbreast reconstruction after breast cancer surgery.Methods The data of 62 patients with breast cancer who completed the modified radical mastectomy from January 2021 to June 2022 in Department of General Surgery of Xuchang Hospital and received the free abdominal flap stageⅠbreast reconstruction after surgery were retrospectively analyzed.All the patients received the skin flap perforator vessel abnormality examination after surgery.According to the survival of the flap,the flap necrosis caused by abnormal blood vessels was included in the necrosis group,the blood vessel status was normal,the flap survival was included in the survival group,and the flap survival rate was calculated.The patient data and main clinical indicators were collected,and the risk factors of the survival rate of free abdominal flap in stageⅠbreast reconstruction after breast cancer surgery were analyzed.Results There were 10 of 62 patients with breast cancer had skin flap necrosis after reconstruction,and the necrosis rate was 16.13%.Logistic regression analysis showed that body mass index(BMI)>28 kg·m^(-2),operation time>8 h,ischemia time>1.5 h,vascular anastomosis time>1 h,and poor blood supply of the flap were risk factors for the survival of free abdominal flap in stageⅠbreast reconstruction(OR>1,P<0.05).Conclusion The survival rate of free abdominal flap is high in stageⅠbreast reconstruction after breast cancer surgery,but there is still a certain risk of necrosis,which may be affected by BMI,operation time,ischemia time,vascular anastomosis time,blood supply of the flap and other factors,which should be paid attention to clinically.