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背景与目的:随着乳腺癌患者预后的不断改善,全乳切除后接受乳房重建手术的患者比例正逐年增高。腹部游离皮瓣是目前应用最多的自体组织乳房重建方法。本研究旨在探讨游离腹壁皮瓣乳房重建在临床实践中的应用价值。方法:对2006年6月—2011年11月在复旦大学附属肿瘤医院接受游离腹壁皮瓣乳房重建的51例乳腺癌患者进行回顾性分析。在51例患者(1例患者为双乳重建,手术计52例次)中,行游离的横行腹直肌(free transverse rectus abdominis myocutaneous,F-TRAM)手术1例次,保留肌肉的F-TRAM19例次,DIEP 32例次。结果:手术成功49例(96.1%)。受区血管的选择:胸廓内血管42例次(80.8%);胸外侧血管1例次(1.9%);肩胛下血管9例次(17.3%)。穿支平均数量为2.31支(1～4支),平均手术时间为8.1 h(4.6～12 h),平均住院时间为20 d(10～39 d),术后平均住院时间为11 d(4～22 d)。在Ⅰ期重建的40例患者中(包括1例双侧Ⅰ期乳房重建),术后化疗有23例(57.5%),其手术距离首次化疗时间为15.6 d(7～33 d)。乳房重建术后乳头重建患者13例(25.5%)。随访1.2～38.5个月,中位随访7.5个月。全部皮瓣坏死2例(3.92%),皮瓣感染1例(1.96%),皮瓣下血肿1例(1.96%),部分脂肪坏死8例(15.69%),腹部并发症3例(5.88%)。患者总体满意度为8.5分。结论:游离腹壁乳房重建有较好的临床应用价值。血供佳,皮瓣组织量大,可以满足大部分患者的需求。术后供区并发症较少,患者对重建形体的满意度较高。但该术式需要较高的手术技巧、先进的手术设备及护理团队的配合。
BACKGROUND & AIM: As the prognosis of breast cancer patients continues to improve, the proportion of patients undergoing breast reconstruction surgery after mastectomy is increasing year by year. Abdominal free flap is the most widely used method of autologous breast reconstruction. This study aimed to investigate the value of free abdominal wall flap reconstruction in clinical practice. Methods: A retrospective analysis was performed on 51 breast cancer patients who underwent free abdominal wall flap reconstruction at the Affiliated Tumor Hospital of Fudan University from June 2006 to November 2011. One case of free transverse rectus abdominis myocutaneous (F-TRAM) surgery was performed in 51 patients (one case of double-breach reconstruction and 52 cases of operation), while the muscle-retaining F-TRAM19 Cases, DIEP 32 cases. Results: The operation was successful in 49 cases (96.1%). The choice of regional blood vessels: thoracic vessels in 42 cases (80.8%); thoracic vessels in 1 case (1.9%); subscapular vessels in 9 cases (17.3%). The average number of perforation was 2.31 (1-4). The average operation time was 8.1 h (4.6-12 h), the average length of hospital stay was 20 d (10-39 d), and the average postoperative hospital stay was 11 d (4) ~ 22 d). Among 40 patients with stage Ⅰ reconstruction (including 1 case of bilateral stage Ⅰ breast reconstruction), 23 cases (57.5%) received postoperative chemotherapy, and the duration of the first chemotherapy was 15.6 days (ranged from 7 to 33 days). Thirteen patients (25.5%) had nipple reconstruction after breast reconstruction. Follow-up ranged from 1.2 to 38.5 months, with a median follow-up of 7.5 months. One case (1.96%) had flap necrosis, one case (1.96%) had flap flaps, eight cases (15.69%) had partial fat necrosis, and three cases (5.88% ). Overall patient satisfaction was 8.5. Conclusion: Free abdominal reconstruction of the breast has a better clinical value. Good blood supply, large amount of tissue flaps, to meet the needs of most patients. Postoperative donor site less complications, patients with higher satisfaction with the reconstruction of the body shape. However, the procedure requires high surgical skills, advanced surgical equipment and nursing teamwork.