外科理论与实践

外科理论与实践 ›› 2023, Vol. 28 ›› Issue (02): 147-151.doi: 10.16139/j.1007-9610.2023.02.11

• 论著 • 上一篇    下一篇

新辅助治疗后腹壁下深血管穿支皮瓣即刻乳房重建手术的安全性研究

高卫奇1, 张旭1, 王铮1, 朱一霏1, 黄佳慧1, 洪进1, 朱思吉1, 陈小松1, 黄欧1, 何建蓉1, 陈伟国1, 李亚芬1, 沈坤炜1, 徐华2(), 吴佳毅1()   

  1. 1.上海交通大学医学院附属瑞金医院普外科 乳腺疾病诊治中心，上海 200025
    2.上海交通大学医学院附属第九人民医院整复外科，上海 200011
  • 收稿日期:2022-08-24 出版日期:2023-03-25 发布日期:2023-06-06
  • 通讯作者: 吴佳毅，E-mail: pinkscorpio@163.com; 徐华，E-mail: plasticxu@163.com

Safety analysis of immediate breast reconstruction with deep inferior epigastric perforator after neoadjuvant treatment

GAO Weiqi1, ZHANG Xu1, WANG Zheng1, ZHU Yifei1, HUANG Jiahui1, HONG Jin1, ZHU Siji1, CHEN Xiaosong1, HUANG Ou1, HE Jianrong1, CHEN Weiguo1, LI Yafen1, SHEN Kunwei1, XU Hua2(), WU Jiayi1()   

  1. 1. Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2. Department of Plastic and Reconstructive Surgery, Shanghai 9th People′s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Received:2022-08-24 Online:2023-03-25 Published:2023-06-06

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摘要：

目的：评估新辅助治疗后病人采用腹壁下深血管穿支（deep inferior epigastric perforator, DIEP）皮瓣行即刻乳房重建手术的安全性。方法：收集2019年1月至2021年2月瑞金医院普外科乳腺疾病诊治中心乳腺癌病人，行乳房全切联合DIEP皮瓣即刻乳房重建术的资料。比较新辅助治疗组与对照组病人的临床病理特征。单因素分析比较两组病人的手术并发症发生率。结果：共研究110例，新辅助治疗组23例（20.9%），对照组87例（79.1%）。相比于对照组，新辅助治疗组无原位癌（0比19.5%，P=0.003），pTNM分期较晚（P<0.001）。两组DIEP皮瓣穿支数（P=0.472）、双蒂皮瓣的占比（P=0.489）、手术时间（P=0.651）以及住院时间（P=0.275）差异均无统计学意义。两组术后并发症发生率差异亦无统计学意义。新辅助治疗组最常见的受区并发症为乳房血清肿（13.0%，3例），未见供区并发症。对照组最常见的受区并发症为脂肪坏死（12.6%，11例），最常见的供区并发症为腹部血清肿（3.4%，3例）。新辅助治疗组与对照组分别有1例（4.3%）和4例（4.6%）二次手术。对照组2例（2.3%）发生DIEP皮瓣坏死并丢失，新辅助治疗组未发生。结论：对于新辅助治疗后的乳腺癌病人，行游离腹壁皮瓣即刻乳房重建是安全的手术方案。

关键词: 乳腺癌, 乳房重建, 新辅助治疗, 腹壁下深血管穿支皮瓣

Abstract:

Objective To evaluate the safety of immediate breast reconstruction using deep inferior epigastric perforator (DIEP) flaps in the patients after neoadjuvant treatment. Methods From January 2019 to February 2021, the data of patients with breast cancer undergoing total mastectomy and immediate breast reconstruction using DIEP flap in Comprehensive Breast Health Center, Department of General Surgery, Ruijin Hospital were collected. Comparison of clinicopathological features was done between neoadjuvant treatment group and control group. Univariate analysis was used to compare the rate of surgical complications between two groups. Results A total of 110 patients were enrolled with 23 cases (20.9%) in neoadjuvant treatment group and 87 cases (79.1%) in control group. None of carcinoma in situ (0 vs. 19.5%, P=0.003) and higher pTNM stage (P<0.001) was present in neoadjuvant treatment group compared with those in control group. However, there were no significant differences in the number of flap perforator of DIEP (P=0.472), the proportion of bipedicled flaps (P=0.489), operative time (P=0.651) and hospital length of stay (P=0.275) between two groups. No significant difference was found in the incidence of postoperative complications between two groups. Breast seroma was the most common recipient complication (13.0%, 3 cases) without donor complication in neoadjuvant treatment group. The most common complication was fat necrosis (12.6%, 11 cases) in recipient site and abdominal seroma (3.4%, 3 cases) in donor site of control group. Reoperation was done in one case (4.3%) of neoadjuvant treatment group and 4 cases (4.6%) of control group. DIEP flap necrosis with total flap loss occurred in 2 cases (2.3%) in control group, but none in neoadjuvant treatment group. Conclusions The imme-diate breast reconstruction with epigastric free flap for breast cancer patients after neoadjuvant treatment would be a safe surgical scheme.

Key words: Breast cancer, Breast reconstruction, Neoadjuvant treatment, Deep inferior epigastric perforator

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