腹腔镜下获取带蒂大网膜瓣在Ⅰ期乳房重建中的应用:附16例病例分析

Laparoscopically harvested pedicled omental flap for one-stage breast reconstruction:An analysis of 16 cases was presented

目的探讨腹腔镜下获取带蒂大网膜瓣(laparoscopically harvested pedicled omental flap,LHPOF)进行乳房重建手术的方法,从患者评估、手术过程、术后随访等方面进行总结分析。方法回顾性收集2022年2月至2023年12月期间于重庆医科大学附属第二医院乳腺甲状腺外科就诊且经病理学检查证实为乳腺癌或浆细胞性乳腺炎,并行LHPOF乳房重建手术患者的临床资料。结果共纳入16例患者,平均年龄43.3岁(27~68岁),平均体质量指数为23.0 kg/m^(2)(18.3~28.6 kg/m^(2))。1例患者术中发现大网膜瓣体积不足而放弃重建,其余15例患者均成功实施了LHPOF乳房重建手术。1例患者术后因大网膜瓣血栓形成导致植入物坏死而行带蒂大网膜瓣切除手术;所有患者术后顺利恢复。患者的平均随访时间13个月(9~17个月),在随访期间,患者主诉症状为轻微的上腹部隆起(2例)和网膜瓣萎缩(1例),无严重的植入物或供体部位并发症如植入物移位、肠道功能障碍和腹壁切口疝等。结论使用LHPOF进行乳房重建手术可实现满意的美容效果,重建后乳房柔软、形态自然。相较于其他自体组织重建方法,带蒂网膜瓣的供体部位和植入物并发症较低。

Objective To explore the methods of breast reconstruction surgery with laparoscopically harvested pedicled omental flap(LHPOF),and analyze the patient’evaluation,operation process and postoperative follow-up.Methods Patients with pathologically proven breast cancer or plasma cell mastitis who underwent LHPOF breast reconstructive surgery were retrospectively collected from the Department of Breast and Thyroid Surgery of The Second Affiliated Hospital of Chongqing Medical University from February 2022 to December 2023.Results A total of 16 patients were collected.The mean age of patients was 43.3(ranging from 27 to 68)years old,the mean body mass index of patients was 23.0 kg/m^(2)(ranging from 18.3 to 28.6 kg/m^(2)).One patient underwent transplant omental flat removal surgery due to postoperative flap thrombosis,and one patient choose to give up breast reconstruction due to insufficient flap volume.The single-stage surgery was performed successfully in the rest patients with no requirement of laparotomy.All patients made an uneventful recovery after surgery.During the follow-up period,which averaged 13 months and ranged from 9 to 17 months,the major symptoms were mild epigastric bulge(2 patients)and flap atrophy(1 patient),no serious flap-related or donor site-related complications such as flap loss,bowel dysfunction and abdominal incisional hernia.In general,the aesthetic results were satisfactory.Conclusions Using LHPOF in immediate breast reconstruction surgery can achieve satisfied aesthetic result,for the soft and natural appearance of the reconstructed breast.In the mean time,compared with other autologous tissue reconstruction approaches,LHPOF has lower incidences of complications of donor-site and flap-site.