腹壁下动脉穿支皮瓣在乳腺癌术后一期乳房再造中的应用

摘要

Objective To evaluate the clinical application of free grafting with the deep inferior epigastric perforator (DIEP) flap on one-stage breast reconstruction following adenomammectomy. Method Clinical results were retrospectively analyzed in 17 sufferers of breast cancer underwent free grafting with DIEP flap one-stage breast reconstruction following radical or modified radical adenomammectomy. Results All flaps survived, and all the reconstructions appeared good outline and good elasticity without fat liquefaction, contractural change,ventral hernia or bulge of abdominal wall. In the 15 cases who were followed up for 1 to 5 years,1 patient died of multiple metastases after 2 years and another patient abandoned treatment because of chest wall recurrence. Conclusions It is demonstrated that mammaplasty through DIEP flaps has much merits such as satisfactory outline, few complications in belly donor site, fine blood supply and abdominal wall reshaping simultaneously. It may be an ideal method of mammaplasty, and chemo or radiotherapy shows no impacts on the growth of flaps.%目的 探讨腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣游离移植在乳腺癌术后一期乳房再造中的临床应用.方法 17例行根治术或改良根治术并同期应用DIEP皮瓣再造乳房的乳腺癌患者,其中Ⅱ期9例,Ⅲ期7例,Ⅳ期1例,行改良根治术Ⅰ式13例,Ⅱ式2例,常规根治术2例.Ⅲ、Ⅳ期患者术前常规新辅助化疗2～3周期.10例术后行放化疗.结果全部皮瓣均成活,再造乳房外形可,弹性好,无脂肪液化、皮瓣挛缩变形; 无腹壁疝和腹壁膨出.15例获随访,平均2.4(1～5)年,1例2年后死于全身转移,1例8个月后胸壁局部复发放弃治疗.结论 乳腺癌术后一期应用DIEP皮瓣游离移植再造乳房,具有皮瓣血运良好、再造乳房外形满意、腹部供区并发症少,可同时行腹壁整形等优点,是乳腺癌术后乳房再造的理想方法之一.且放化疗不影响皮瓣的成活.