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目的探讨吻合血管的腹部皮瓣在乳腺肿瘤切除术后乳房整形中的应用效果。方法回顾性分析自2014年3月至2016年3月,60例乳腺肿瘤患者应用腹部皮瓣行一期乳房重建或乳腺癌术后创面修复,术中进行不同数量的血管吻合。结果应用吻合血管的腹部皮瓣行一期乳房重建50例;乳腺肿瘤术后创面修复10例。其中带蒂横行腹直肌皮瓣(TRAM)+腹壁浅静脉(SIEV)吻合10例;单蒂腹壁下动脉穿支皮瓣(DIEP)40例;TRAM+对侧DIEP皮瓣8例;双蒂DIEP皮瓣2例。术后出现血管危象2例,切口感染2例,皮瓣Ⅳ区部分坏死2例,腹部膨隆2例,皮下血肿1例,皮瓣下脂肪液化1例,供区脂肪液化1例,脐坏死1例,无腹壁疝等并发症发生。57例患者术后获随访6~29个月,远处转移2例,局部复发1例。乳房重建患者总体满意度较高,局部晚期患者术后创面及时修复,生活质量明显提高。结论采用多种形式吻合血管的腹部皮瓣行乳房重建或创面修复,血供可靠,临床效果较满意。
Objective To investigate the application of vascular flap in breast reconstruction after breast tumor resection. Methods Retrospective analysis from March 2014 to March 2016, 60 cases of breast cancer patients with abdominal skin flap reconstruction surgery or breast cancer wound repair, intraoperative different amounts of vascular anastomosis. Results Fifty cases of primary breast reconstruction with vascular flap were performed. Ten cases were repaired after breast tumor surgery. TRTI + SIEV was performed in 10 cases, mono-pedicled inferior epicardial perforator flap (DIEP) in 40 cases, TRAM + contralateral DIEP flap in 8 cases, double-pedicled DIEP Flap in 2 cases. Postoperative vascular crisis in 2 cases, incision infection in 2 cases, partial necrosis in 2 cases of skin flap in 2 cases, 2 cases of abdominal bulging, subcutaneous hematoma in 1 case, 1 case of subcutaneous fat liquefaction, for the area of fat liquefaction in 1 case, umbilical necrosis 1 case, no abdominal hernia and other complications occurred. 57 patients were followed up for 6 to 29 months, distant metastasis in 2 cases, local recurrence in 1 case. Patients with breast reconstruction had higher overall satisfaction, and the wounds in patients with locally advanced disease were promptly repaired and the quality of life improved significantly. Conclusions The flap of the abdomen with various forms of vascular anastomosis can be repaired by breast reconstruction or wound, the blood supply is reliable and the clinical effect is satisfactory.