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目的探讨腹壁下动脉穿支(DIEP)皮瓣应用于乳房再造术中的效果。方法选取2009年1月至2014年7月收治的18例保留乳房的乳腺癌改良根治术以及10例Poland综合征患者,其中18例患者选择进行一侧DIEP皮瓣再造手术,作为观察组;其余10例进行一期背阔肌皮瓣转移联合扩张器植入,3~5个月后行二期乳房假体植入术,作为对照组。若双侧乳房出现不对称,则需要同时对对侧乳房进行缩小处理,达到对称性。比较两组手术情况、术后生活质量评分及并发症发生情况。结果观察组中15例患者术后基本对称,3例需要进行二期修整。对照组中10例患者需要进行对侧乳房的处理,而经过处理后,与DIEP再造术相比,对称感仍不足。观察组术后乳房对称例数较对照组明显增多,需要二次手术患者明显减少(P均<0.01)。观察组术后6个月的生理健康、心理健康、独立能力、社会关系四个方面生活质量评分均明显优于对照组(P均<0.01)。观察组并发症发生率为22.22%,而对照组为50.00%,组间比较差异无统计学意义(P>0.05)。结论相比于背阔肌皮瓣乳房再造术,DIEP乳房再造术无需进行二次修整手术,且术后双侧乳房的对称效果更好。
Objective To investigate the effect of subcutaneous abdominal artery perforating branch (DIEP) flap in breast reconstruction. Methods 18 cases of breast conserving breast cancer modified radical mastectomy and 10 cases of Poland syndrome admitted to our hospital from January 2009 to July 2014 were enrolled. Among them, 18 cases underwent DIEP flaps reconstruction as the observation group. The rest Ten patients underwent latissimus dorsi flap transfer and dilator implantation. Three to five months later, second-stage breast implants were performed as a control group. If bilateral breast asymmetry, you need to contralateral breast contracted to achieve symmetry. The operation conditions, postoperative quality of life score and complications were compared between the two groups. Results In the observation group, 15 patients were basically symmetrical after operation, and 3 patients needed second-stage dressing. Ten patients in the control group required contralateral breast treatment, and after treatment, symmetry was still inadequate compared with DIEP. The number of postoperative breast symmetry in the observation group was significantly higher than that in the control group, and the number of patients requiring secondary surgery was significantly decreased (all P <0.01). The quality of life scores of the observation group were significantly better than those of the control group (P <0.01) at 6 months after the operation in all four aspects of physical health, mental health, independence and social relations. The incidence of complications in the observation group was 22.22%, while that in the control group was 50.00%. There was no significant difference between the two groups (P> 0.05). Conclusion Compared with latissimus dorsi flap breast reconstruction, DIEP breast reconstruction without secondary dressing surgery, and postoperative bilateral breast symmetry better.