目的

总结乳腺癌切除同时应用腹壁下动脉穿支(DIEP)皮瓣行即刻乳房重建的手术经验,探讨DIEP 皮瓣即刻乳房重建的适应证及优点。

方法

2003年4月至2009年6月,中国医学科学院肿瘤医院乳腺中心接受乳腺癌切除术患者21 例(根治术6 例,改良根治术15 例),术前应用多排螺旋CT (MDCT)血管造影及多普勒血流仪探明穿支位置,乳腺癌切除的同时,解剖腹壁下动脉穿支,形成腹壁下动脉穿支蒂皮瓣,与患侧胸背血管吻合,进行即刻乳房重建。

结果

术后随访6 个月至6年。21例患者中,20 例皮瓣全部存活,1 例出现皮瓣远端1/3 脂肪液化; 胸部受区出现1 例血肿; 无腹壁膨隆、腹壁疝、切口脂肪液化等供区并发症; 再造乳房外形满意,形态自然。

结论

乳腺癌切除同时,采用DIEP 皮瓣进行即刻乳房重建,可以使患者免受乳房缺失的痛苦,同时具有受区组织条件好、皮瓣组织量丰富、供区损伤小及并发症少的优点,是一种理想的即刻乳房重建方法。

Objective

To summarize the experiences of immediate breast reconstruction with deep inferior epigastric perforator (DIEP) flap and to evaluate indications and advantages of the technique.

Methods

From April 2003 to June 2009,immediate breast reconstruction following mastectomy using DIEP flap was performed in 21 patients who had received mastectomy for stage I and II breast cancer (radical mastectomy in 6 cases and modified radical mastectomy in 15). Before the operation the location of DIEP was determined by using MDCT (multidetector computed tomography) angiography and Doppler perfusion flowmeter. When mastectomy was completed DIEP was dissected to obtain DIEP flap simultaneously. And the deep inferior epigastric vessels were anastomosed to the thoracodorsal vessel for immediate breast reconstruction.

Results

The follow-up time was 6 months to 6 years. Among the 21 patients 20 had their flaps completely survived postoperatively,fat necrosis of the distal part (1/3) occurred in one. One case suffered from hematoma in recipient site. No complications such as abdominal hernia and bulge or fat necrosis in donor sites were found. The reconstructed breasts were well-shaped.

Conclusion

Immediate breast reconstruction using DIEP flap possesses the advantages of satisfactory recipient condition,abundant tissue volume and minimal donor site injury.