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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2019, Vol. 13 ›› Issue (02) : 69 -74. doi: 10.3877/cma.j.issn.1674-0807.2019.02.002

所属专题： 文献；

论著

吲哚菁绿血管造影在带蒂横行腹直肌皮瓣乳房重建术中的应用
黄清丰1, 杨迎旭2, 薛会朝3,†(), 尹健4, 丁泊文4, 殷竹鸣4   
  1. 1. 453100　河南省新乡医学院第一附属医院乳腺甲状腺外科；300060　天津医科大学肿瘤医院乳房再造科
    2. 450007　郑州大学附属郑州中心医院乳腺甲状腺外科
    3. 453100　河南省新乡医学院第一附属医院乳腺甲状腺外科
    4. 300060　天津医科大学肿瘤医院乳房再造科
  • 收稿日期:2018-08-20 出版日期:2019-04-01
  • 通信作者: 薛会朝
  • 基金资助:
    河南省科技厅科技公关项目(17210310405)

Application of indocyanine green angiography in breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap

Qingfeng Huang1, Yingxu Yang2, Huichao Xue3,†(), Jian Yin4, Bowen Ding4, Zhuming Yin4   

  1. 1. Department of Breast and Thyroid Surgery, First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453100, China; Department of Breast Reconstruction, Cancer Institute and Hospital of Tianjin Medical University, Tianjin 300060, China
    2. Department of Breast and Thyroid Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450007, China
    3. Department of Breast and Thyroid Surgery, First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453100, China
    4. Department of Breast Reconstruction, Cancer Institute and Hospital of Tianjin Medical University, Tianjin 300060, China
  • Received:2018-08-20 Published:2019-04-01
  • Corresponding author: Huichao Xue
  • About author:
    Corresponding author: Xue Huichao, Email:
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引用本文：

黄清丰, 杨迎旭, 薛会朝, 尹健, 丁泊文, 殷竹鸣. 吲哚菁绿血管造影在带蒂横行腹直肌皮瓣乳房重建术中的应用[J]. 中华乳腺病杂志(电子版), 2019, 13(02): 69-74.

Qingfeng Huang, Yingxu Yang, Huichao Xue, Jian Yin, Bowen Ding, Zhuming Yin. Application of indocyanine green angiography in breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap[J]. Chinese Journal of Breast Disease(Electronic Edition), 2019, 13(02): 69-74.

目的

探讨应用吲哚菁绿(ICG)血管造影指导带蒂横行腹直肌(TRAM)皮瓣乳房重建术中皮瓣修剪的可行性。

方法

采用前瞻性研究方法，分析天津医科大学肿瘤医院和郑州大学附属郑州中心医院2015年1月至2017年6月收治的64例带蒂TRAM皮瓣乳房重建患者的临床资料。使用随机数字表法将患者分为造影组(34例)和对照组(30例)。造影组采用ICG血管造影指导TRAM皮瓣修剪，对照组采用传统经验修剪皮瓣。2组患者术后12 h皮瓣血供异常发生率、皮瓣相关并发症发生率及重建乳房术后外观评价等级的比较，均采用χ2检验，患者术后总体满意度评分比较采用t检验。

结果

造影组患者未出现ICG血管造影相关并发症，并且，依据造影结果切除血流灌注不良的部分后，乳房塑形满意。造影组患者术后12 h皮瓣血供异常发生率为2.9% (1/34)，对照组为13.3% (4/30)，2组比较，差异无统计学意义(χ2＝1.165，P＝0.280)；并且，造影组患者皮瓣相关并发症发生率为2.9%(1/34)，对照组为10.0%(3/30)，2组比较，差异也无统计学意义(χ2＝0.418，P＝0.518)。术后随访1年，造影组患者乳房外观评价为非常好者占97.1%(33/34)，明显高于对照组的76.7%(23/30)(χ2＝4.338，P＝0.037)；造影组与对照组患者总体满意度评分分别为(8.91±0.38)分和(8.47±0.57)分，2组比较，差异有统计学意义(t＝3.622, P＝0.001)。

结论

吲哚菁绿血管造影能在术中动态显示带蒂TRAM皮瓣的血供范围，对指导皮瓣修剪有一定的帮助，有助于获得较好的乳房外观。

关键词: 吲哚花青绿, 血管造影术, 乳房成形术
Objective

To investigate the feasibility of indocyanine green angiography-guided breast reconstruction using the pedicled transverse abdominis myocutaneous (TRAM) flap.

Methods

This prospective study analyzed the clinical data of 64 patients who underwent breast reconstruction with TRAM flap in Cancer Institute and Hospital of Tianjin Medical University and Zhengzhou Central Hospital Affiliated to Zhengzhou University between January 2015 and June 2017. All cases were divided into the angiography group (34 cases) and the control group (30 cases) by the random number table method. In the angiography group, indocyanine green angiography was used to guide the trim of the flap, while the flap was trimmed in a conventional way in the control group. The incidence of abnormal blood supply in postoperative 12 hours, the flap-related complications and postoperative appearance of the reconstructed breast were compared between two groups using χ2 test. The patient satisfaction was compared between two groups using t test.

Results

In the angiography group, there were no complications related to indocyanine green angiography and the reconstructed breast presented a good appearance after the part of flap was with poor perfusion resected according to the ICG angiography. The incidence of abnormal blood supply in the flap in postoperative 12 hours was 2.9% (1/34) in the angiography group and 13.3% (4/30) in the control group, indicating no significant difference (χ2=1.165, P=0.280). The incidence of flap-related complications was 2.9% (1/34) in the angiography group and 10.0% (3/30) in the control group, indicating no significant difference (χ2=0.418, P=0.518). All the patients were followed up for one year.The patients with good postoperative breast appearance accounted for 97.1% (33/34) in the angiography group, significantly higher than 76.7% (23/30) in the control group (χ2=4.338, P=0.037). The score of overall patient satisfaction was 8.91±0.38 in the angiography group and 8.47±0.57 in the control group, suggesting a significant difference (t=3.622, P= 0.001).

Conclusion

Indocyanine green angiography can dynamically show blood perfusion of the pedicled TRAM flap, which can provide the guidance for flap trimming in order to achieve a better breast appearance.

Key words: Indocyanine green, Angiography, Mammaplasty
图1 Hartrampf腹部皮瓣血供分区示意图
表1 带蒂横行腹直肌皮瓣血流灌注级别评价标准
级别 标准
A级 血流灌注优良区域，显影明显，造影剂充盈明显，与周围正常皮肤一致
B级 血流灌注较好区域，显影较明显，造影剂充盈明显，较周围正常皮肤稍弱
C级 血流灌注一般区域，有显影，造影剂有显示，但较周围正常皮肤明显减弱
D级 血流无灌注区域，无显影，造影剂无显示
表2 乳房重建患者术后外观评价标准
等级 标准
非常好 重建乳房的大小、外形与对侧乳房一致，质软，弹性好
较好 重建乳房的形态与对侧乳房相差小于1/4，质软，弹性好
一般 重建乳房的形态与对侧乳房相差1/4～1/2，质稍韧，弹性稍差
较差 重建乳房的形态与对侧乳房相差大于1/2，质韧，弹性差
表3 造影组与对照组乳房重建患者临床资料比较
组别 例数 年龄(岁，±s) 体质指数(kg/m2，±s) 乳房重建时机(例) 术后放射治疗(例)
即刻 延期
造影组 34 45.0±5.6 24.2±1.0 20 14 7
对照组 30 45.2±5.9 24.3±0.8 17 13 5
检验值 ? t＝－0.182 t＝－0.521 χ2＝0.030 χ2＝0.161
P值 ? 0.856 0.604 0.862 0.688
图2 乳腺癌患者行乳房重建手术时吲哚菁绿在带蒂TRAM皮瓣中的显影效果　a图为术中ICG显示皮瓣血供情况(Ⅳ区为缺乏血供区)；b图所示术中拟修剪的带蒂TRAM皮瓣
表4 造影组与对照组乳房重建患者术后12 h皮瓣血供异常发生率及皮瓣相关并发症发生率比较[例(%)]
组别 例数 皮瓣血供异常 皮瓣相关并发症
造影组 34 1(2.9)　 1(2.9)　
对照组 30 4(13.3) 3(10.0)
χ2值 ? 1.165 0.418
P值 ? 0.280 0.518
图3 造影组患者行乳腺癌改良根治术＋TRAM皮瓣即刻乳房重建手术前后对比　a图所示患者术前乳房及供区外观；b图所示患者术后3个月时重建乳房外观
表5 造影组与对照组乳房重建患者自我满意度评分比较(分)
组别 例数 总体满意度 触感满意度 外形满意度 对称满意度
造影组 34 8.91±0.38 8.56±0.56 8.79±0.48 8.82±0.46
对照组 30 8.47±0.57 8.47±0.57 8.37±0.56 8.27±0.52
t值 ? 3.622 0.65　 3.274 4.549
P值 ? 0.001 0.518 0.002 <0.001
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