CAJ | 학술논문

目的评价保乳手术联合应用带蒂胸背动脉穿支(thoracodorsal artery perforator,TDAP)皮瓣行一期乳房部分重建(immediate partial breast reconstruction,IPBR)的皮瓣设计、手术结果、重建乳房外观以及供皮区并发症情况.方法回顾性分析复旦大学附属肿瘤医院乳腺外科2004年11月-2010年11月13例应用带蒂TDAP皮瓣行BCS+ IPBR手术的乳腺癌患者随访资料.结果胸背动脉主要穿支的位置位于腋后线、腋皱襞下7.5～9.5 cm(中位距离8.0 cm),穿支术前多普勒超声体表定位与术中解剖的位置符合率为100％.单纯解剖穿支1例,余12例均在穿支周围保留1.0～3.0cm宽度的部分背阔肌.术后随访4～71个月,中位随访时间41个月.所有皮瓣均存活,供区均无血清肿及背阔肌功能障碍.重建乳房的外观以患者自我评价及门诊随访医生评价相结合的方式进行评估,结果9例为优良,3例为一般,1例为差.结论 TDAP皮瓣能满足乳腺癌保乳术后任何象限的局部缺损修复和重建,特别对于肿块局部切除活检后保乳的患者来说,能很好的重塑乳房外形,患者满意度较高.术前应用手持式多普勒超声对胸背动脉的主要穿支进行体表定位,有助于术中快速找寻及解剖穿支,减少血管损伤及血管危象的发生.
목적 평개보유수술연합응용대체흉배동맥천지(thoracodorsal artery perforator,TDAP)피판행일기유방부분중건(immediate partial breast reconstruction,IPBR)적피판설계、수술결과、중건유방외관이급공피구병발증정황.방법 회고성분석복단대학부속종류의원유선외과2004년11월-2010년11월13례응용대체TDAP피판행BCS+ IPBR수술적유선암환자수방자료.결과 흉배동맥주요천지적위치위우액후선、액추벽하7.5～9.5 cm(중위거리8.0 cm),천지술전다보륵초성체표정위여술중해부적위치부합솔위100％.단순해부천지1례,여12례균재천지주위보류1.0～3.0cm관도적부분배활기.술후수방4～71개월,중위수방시간41개월.소유피판균존활,공구균무혈청종급배활기공능장애.중건유방적외관이환자자아평개급문진수방의생평개상결합적방식진행평고,결과9례위우량,3례위일반,1례위차.결론 TDAP피판능만족유선암보유술후임하상한적국부결손수복화중건,특별대우종괴국부절제활검후보유적환자래설,능흔호적중소유방외형,환자만의도교고.술전응용수지식다보륵초성대흉배동맥적주요천지진행체표정위,유조우술중쾌속조심급해부천지,감소혈관손상급혈관위상적발생.
Objective To discuss the design of pedicled thoracodorsal artery perforator flap (TDAP flap),and to evaluate the aesthetic results and donor-site complications for immediate partial breast reconstruction (IPBR) after breast conserving surgery (BCS) for breast cancer patients.Method Clinical data of 13 breast cancer cases treated with BCS + IPBR using TDAP flap from November 2004 to November 2010 were retrospectively analyzed.Perforators were identified with Doppler preoperatively in all patients.Results All perforators originated within a median distance of 8.0 cm ( range,7.5 to 9.5 cm) from axillary plica at the posterior line of axilla.Median area of the flaps was 6.0 × 8.0 cm ( range,5.0 × 7.0 cm to 8.0 × 10.0 cm).One flap was muscle-sparing,while a small muscle strip was left embedding the perforators in other twelve flaps to increase the reliability of the vascular pedicle.Postoperatively patients were followedup from 4 to 71 months.Median follow-up time was 41 months.Flap necrosis and seroma in the donor-site were not found in all patients.Aesthetic results were graded as excellent or good in 9 patients,fair in 3,and poor in one.Conclusions TDAP flap is a good choice for IPBR after BCS for breast cancer patients whether lesions in outer quadrants or inner quadrants,especially for those patients with excisional biopsy.Preoperative mini-Doppler is helpful for determining the precise location of the main perforators,and decreasing the risk of vessels injury.