目的： 术前及术中评估中国人胸廓内动脉肋间穿支（internal mammary artery perforator, IMAP）解剖特点,探讨IMAP为腹壁下动脉穿支（deep inferior epigastric perforator, DIEP）皮瓣乳房重建受区血管的成功率。方法： 对2016年1月至2018年12月连续98例DIEP皮瓣一期乳房重建病例进行分析,分为IMAP组32例,胸廓内动脉组66例。所有病人术前均行多普勒超声评估血管。自2017年1月起,73例同时术前行CT血管造影（computed tomographic angiography, CTA）评估血管。分析所有病人患侧IMAP分布位置和管径,以及作为受区血管的使用率。结果： 98例病人中,IMAP 66例（67.3%）位于第二肋间,直径（1.33±0.66） mm,24例（24.5%）位于第三肋间,直径（0.86±0.28） mm,8例（8.2%）位于第四肋间,直径（0.65±0.15） mm。98例DIEP皮瓣重建病人中,32例（32.7%）使用IMAP作为受区血管,其中28例（87.5%）位于第二肋间,4例（12.5%）位于第三肋间。在病人特征和皮瓣并发症等方面,IMAP组与胸廓内动脉组差异无统计学意义。术前CTA和超声检查双重定位的73例病人中,29例（39.7%）使用IMAP,远高于仅行超声检查的12.0%（3/25） （P=0.01）。结论： IMAP是一种可靠的DIEP皮瓣一期乳房重建受区血管。术前CTA检查可提高IMAP的使用成功率。IMAP作为受区吻合血管可简化手术步骤、缩短手术时间、减少胸壁损伤、避免牺牲胸廓内血管主干。
Objective To study the anatomy of internal mammary artery perforator (IMAP) in Chinese patients and the utilization rate of IMAP as recipient vessels for deep inferior epigastric perforator(DIEP) flap breast reconstruction. Methods Ninty-eight consecutive cases with DIEP flap in immediate breast reconstruction from January 2016 to December 2018 were analyzed, 32 cases in IMAP group and 66 cases in internal mammary artery group. All cases had preoperative mapping of perforator with ultrasound. A total of 73 cases had preoperative mapping of perforator with CT angiography (CTA) simultaneously since January 2017. The location and diameter of IMAP were analyzed as well as the utilization rate of IMAP as recipient vessels. Results In 98 cases, IMAP was located in the second intercostal space (ICS) in 66 (67.3%) cases, diameter (1.33±0.66) mm, in the third ICS in 24 (24.5%) cases, diameter (0.86±0.28) mm, and in the fourth ICS in 8 (8.2%) cases, diameter (0.65±0.15) mm. IMAP was used in DIEP flaps in 32 (32.7%) case. A total of 28 (87.5%) perforators were located in the second ICS and 4 (12.5%) perforators in the third ICS. There was no significant difference between IMAP group and internal mammary artery group in patient characteristics and flap complications. The utilization rate of IMAP was 39.7% (29/73) in patients using CTA which was much higher than 12.0% (3/25) in patients without using CTA(P=0.01). Conclusions IMAP as recipient vessel is viable alternative for immediate DIEP flap breast reconstruction when applicable. Preoperative CTA can improve the utilization rate of IMAP. This strategy offers the advantages of decreasing recipient site morbidity, reducing operative time and simplifying procedures.
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