携带淋巴组织的横行腹直肌皮瓣移植乳房再造治疗上肢淋巴水肿1例附文献复习

目的  总结采用携带淋巴组织的横行腹直肌皮瓣移植进行乳房再造并治疗上肢淋巴水肿的临床经验。方法  中国医学科学院整形外科医院收治的1例乳腺癌根治术后7年右侧上肢淋巴水肿的患者, 经术前淋巴造影证实为腋窝淋巴回流障碍。应用携带淋巴组织的横行腹直肌皮瓣移植进行胸壁修复、乳房再造及淋巴回流重建, 并彻底松解腋窝严重挛缩瘢痕。术后对该病例双侧上肢周径进行长期监测。结果  该病例术后出现移植皮瓣严重水肿, 术后引流量达755 mL/d, 长达5 d, 伴随心房颤动、低蛋白血症、低钾血症及切口延迟愈合等术后并发症。经过及时引流及规范综合治疗, 术后转归良好, 患侧上肢周径逐渐缩小, 术后3周趋于稳定。术后随访5年效果较好。结论  应用携带淋巴组织的横行腹直肌皮瓣移植进行乳房再造同时治疗乳腺癌根治术后上肢淋巴水肿, 可取得良好的临床效果。

Transverse rectus abdominis myocutaneous flap transplantation with lymphatic tissues for breast reconstruction in treatment of upper limb lymphedema:report of one case with literature review

Objective To summarize the clinical experience of breast reconstruction using transverse rectus abdominis myocutaneous flap transplantation with lymphatic tissues in the treatment of the upper limb lymphedema. Methods One patient presenting with lymphedema of the right upper limb at 7 years after radical mastectomy for breast cancer was admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences.She was diagnosed with axillary lymphatic flow disorders by preoperative lymphography.The transverse rectus abdominis myocutaneous flap with lymphatic tissue was used for chest wall repair, breast reconstruction and lymphatic flow reconstruction, and thoroughly relieved the severe axillary contracture scars.The circumferences of bilateral upper limbs of the patient were monitored postoperatively for long term. Results After the operation, severe edema occurred in the transplant skin flap.The postoperative drainage volume reached 755 mL/d for 5 d, accompanied by multiple postoperative complications, such as atrial fibrillation, hypoproteinemia, hypokalemia and delayed incisional healing.After timely drainage and standardized comprehensive treatment, excellent postoperative outcomes were obtained.The circumference of the affected upper limb was gradually decreased.The patient was stabilized at postoperative 3 weeks.Excellent surgical efficacy was achieved during 5-year follow-up. Conclusions Transverse rectus abdominis myocutaneous flap transplantation with lymphatic tissues for breast reconstruction is an efficacious treatment of the upper limb lymphedema after radical mastectomy for breast camcer.