Clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer
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摘要:
目的 探讨带蒂肋间前动脉穿支皮瓣在乳腺癌保乳术后乳房重建中的临床应用效果。 方法 该研究为回顾性观察性研究。2023年1—12月,西南医科大学附属医院乳腺外科收治16例符合入选标准的乳腺癌女性患者,年龄（48±8）岁。采用带蒂肋间前动脉穿支皮瓣对患者进行保乳术后乳房重建：完整切除肿瘤组织后,于乳房下皱襞设计“新月形”切口,根据肿瘤位置及切除肿瘤组织后缺损面积切取带蒂肋间前动脉穿支皮瓣,将皮瓣去表皮后进行对合、顺向或逆向旋转填补缺损。将供区创面逐层拉拢缝合。统计术中乳房组织损失量、手术时长、引流管留置时长、乳房切缘组织肿瘤阳性比例、乳房丢失比例,以及术后皮瓣成活情况、并发症的发生比例。随访局部肿瘤复发或远处转移情况。末次随访时,采用Ueda评分对保乳术后重建乳房进行美容评估,应用Breast-Q量表2.0版对患者进行保乳术后乳房重建满意度及生活质量评估。 结果 该组患者术中乳房组织损失量为20~128（59±34）cm3,手术时长为105~200（143±27）min,引流管留置时长为3~7（4.6±1.0）d,乳房切缘组织肿瘤阳性比例为1/16,乳房丢失比例为0。术后,患者移植皮瓣均成活。术后1例患者术区脂肪液化,术后并发症发生比例为1/16。随访3~12（11±4）个月,患者均未发生局部乳腺癌复发或远处转移。末次随访时,患者保乳术后重建乳房美容评分结果：优秀6例、良好8例、尚可2例,优良比例为14/16。末次随访时,患者保乳术后乳房重建满意度及生活质量评估中评分最高的是对外科医师的满意度,评分为59~100（91±13）分；其次是胸部生理健康,评分为60~100（77±14）分；随后依次为心理健康评分35~100（74±20）分、对乳房的满意度评分55~100（73±13）分、对获取信息的满意度评分53~100（70±14）分和性健康评分34~100（70±23）分。 结论 带蒂肋间前动脉穿支皮瓣用于乳腺癌保乳术后乳房重建安全、可靠,能够取得较高的美容效果和患者满意度；该皮瓣设计简单、操作方便、可重复性强,值得临床推广应用。 -
关键词:
- 乳腺肿瘤 /
- 穿支皮瓣 /
- 肋间前动脉穿支皮瓣 /
- 保乳术后乳房重建手术 /
- 创面修复
Abstract:Objective To investigate the clinical application effects of the pedicled anterior intercostal artery perforator flap in breast reconstruction after breast-conserving surgery for breast cancer. Methods This study was a retrospective observational study. From January to December 2023, 16 female breast cancer patients who met the inclusion criteria were hospitalized in the Department of Breast Surgery of the Affiliated Hospital of Southwest Medical University, with the age of (48±8) years. The pedicled anterior intercostal artery perforator flap was used for breast reconstruction of patients after breast-conserving surgery. After complete tumor resection, a "crescent-shaped" incision was designed at the inframammary fold. The pedicled anterior intercostal artery perforator flap was harvested based on tumor location and defect size after resection of tumor tissue. The flap was de-epithelialized and rotated anterogradely or retrogradely to fill the defect. The donor site wound was closed with layered sutures. The following parameters were recorded: breast tissue loss volume during surgery, surgical duration, retention duration of the drainage tube, positive proportion of tumors in the breast incision margin tissue, breast loss ratio, flap survival rate, and incidence of complications after operation. Patients were followed up for local recurrence or distant metastasis of tumor. At the last follow-up, the Ueda score was used to evaluate cosmetic outcomes of reconstructed breasts after breast-conserving surgery, and the Breast-Q scale version 2.0 was applied to assess patients' satisfaction and quality of life with breast reconstruction after breast-conserving surgery. Results The breast tissue loss volume during surgery in this group of patients was 20-128 (59±34) cm³, the surgical duration was 105-200 (143±27) min, the retention duration of the drainage tube was 3-7 (4.6±1.0) d, and the positive proportion of tumors in the breast incision margin tissue was 1/16, with breast loss ratio of 0. After the surgery, the patient's transplanted flaps all survived. One patient had postoperative fat liquefaction in the surgical area, and the incidence of postoperative complications was 1/16. The patients were followed up for 3-12 (11±4) months, and no local breast cancer recurrence or distant metastasis occurred. At the last follow-up, the cosmetic score of breast reconstruction after breast-conserving surgery showed that 6 cases were excellent, 8 cases were good, and 2 cases were still acceptable, with an excellent and good ratio of 14/16. At the last follow-up, the highest score in the satisfaction and quality of life assessment of patients with breast reconstruction after breast-conserving surgery was the satisfaction with the surgeons, with a score of 59-100 (91±13). Next was the physiological health of the chest, with a score of 60-100 (77±14). Subsequently, the scores were 35-100 (74±20) for psychological health, 55-100 (73±13) for breast satisfaction, 53-100 (70±14) for information acquisition satisfaction, and 34-100 (70±23) for sexual health. Conclusions The pedicled anterior intercostal artery perforator flap is safe and reliable for breast reconstruction after breast-conserving surgery for breast cancer, and can achieve high cosmetic effects and patient satisfaction. This flap has a simple design, easy operation, and strong repeatability, and is worthy of clinical promotion and application. -
参考文献
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图 1 AICAP解剖示意图及术中显露情况。1A.解剖示意图；1B.皮瓣内AICAP（黑色箭头指示）；1C.皮瓣外侧AICAP（黑色箭头指示）
注：AICAP为肋间前动脉穿支
图 2 采用不同方式转移带蒂肋间前动脉穿支皮瓣对不同位置乳腺肿瘤患者行保乳术后乳房重建。2A、2B、2C.分别显示肿瘤位于右侧乳房内下象限、左侧乳房内下象限、右侧乳房内上象限,图2A与2B切口设计位于乳房下皱襞；2D、2E、2F.分别为针对图2A、2B、2C各位置乳腺肿瘤的皮瓣转移方式,图2D为以蒂部为支点进行逆向旋转填补缺损,图2E为以蒂部为支点进行顺向旋转填补缺损,图2F因残腔下方仍留有腺体瓣而将腺体瓣向上推移填补部分残腔后用带蒂皮瓣填补剩余残腔进行乳房重建
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