应用游离腹部皮瓣行118例乳房重建术的单中心报告

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1复旦大学附属肿瘤医院乳腺外科,复旦大学上海医学院肿瘤学系,上海200032

2美国德克萨斯大学MD.Anderson癌症中心整形外科,休斯顿77030


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背景与目的随着诊疗技术的不断革新,乳腺癌的无病生存期和总生存率显著提高。为了改善患者术后的生活质量,越来越多的乳房重建技术被应用于临床。本文拟通过回顾复旦大学附属肿瘤医院乳腺外科118例游离腹部皮瓣乳房重建术的开展情况,介绍该术式的手术方法及结果,并就开展过程中的心得体会加以阐述。方法收集2006年11月-2013年6月117例(1例接受双侧重建)接受全乳切除并进行即刻或延期游离腹部皮瓣乳房重建的患者进行即刻或延期游离腹部皮瓣乳房重建的临床资料,分析手术情况、围手术期并发症发生率及远期转归。结果在上述观察期间共完成118例游离腹部皮瓣乳房重建术,平均手术时间7.72 h,平均热缺血时间78.74 min,平均血管吻合时间60.83 min。保留腹壁下深血管穿支平均为3支,胸廓内血管为首选的受区血管。术后发生血管危象10例,其中静脉血栓6例,静脉成角4例解救成功7例,皮瓣全部坏死3例,成功率为97.46%。术后伤口感染发生率为7.00%,下腹部膨隆发生率为3.50%,无腹壁疝发生。手术距首疗程化疗的中位时间为19 d。中位随访12个月,1例出现远处转移,未发现局部复发。结论游离腹部皮瓣乳房重建术可获得较佳的重建乳房外观,虽然该术式较为复杂,对术者要求高,存在学习曲线,但术式成功率高,术后并发症较少,不影响肿瘤安全性,值得推广。

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