中国修复重建外科杂志

中国修复重建外科杂志

吲哚菁绿血管造影在自体组织乳房重建中的应用

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目的探讨吲哚菁绿(indocyanine green,ICG)血管造影用于自体组织乳房重建术的疗效。方法2016 年 6 月—2017 年 6 月,收治 14 例拟行自体组织乳房重建术的女性患者。患者年龄 27~64 岁,中位年龄 46.5 岁。一期重建 11 例,其中乳腺原发浸润性导管癌 9 例、胸壁乳腺癌复发 1 例、血管肉瘤 1 例;病程 9 d~48 个月,平均 6.8 个月。二期重建 3 例,均为乳腺癌改良根治术后 3~4 年。术中于皮瓣断蒂前行 ICG 血管造影,评估皮瓣血运灌注情况,根据结果除 1 例未作调整外,余 13 例行裁剪皮瓣或调整重建方案。皮瓣移位至受区、切口缝合前再次行 ICG 血管造影,明确皮瓣血运。皮瓣切取范围为 24 cm×11 cm~36 cm×15 cm。供区均拉拢缝合。结果术后 1 例 2 型糖尿病患者发生皮瓣脂肪液化,经再次手术清创后愈合。其余患者皮瓣均成活,未发生与皮瓣血运相关的并发症;供受区均Ⅰ期愈合。患者均获随访,随访时间 1~14 个月,平均 4 个月。患者均对重建效果满意,随访期间无肿瘤复发。结论ICG 血管造影可准确反映术中皮瓣血流灌注状态,对指导乳房重建手术方案的调整以及降低术后皮瓣血运相关并发症具有积极意义。

ObjectiveTo investigate the effect of indocyanine green (ICG)-based fluorescent angiography in autologous tissue breast reconstruction.MethodsBetween June 2016 and June 2017, 14 female patients were treated with the autologous tissue breast reconstruction. The age ranged from 27 to 64 years with the median age of 46.5 years. There were 11 patients of one-stage reconstruction, including 9 with invasive ductal carcinoma of breast, 1 with recurrence tumor on chest wall, and 1 with angiosatcoma in the breast. The disease duration ranged from 9 days to 48 months (mean, 6.8 months). There were 3 patients of second-stage breast reconstruction, who underwent mastectomy 3-4 years ago. During operation, the first ICG-based fluorescent angiography was done before cutting off the flap pedicle. According to the results, 13 patients were adjusted the strategy of operation or cut part of flap, only 1 patient kept the original design. Then, the infusion of flaps were confirmed by the second ICG-based fluorescent angiography after transplanted to the recipient site. The area of flap ranged from 24 cm×11 cm to 36 cm×15 cm. All incisions of recipient site were closed by primary suture.ResultsThe fat liquefaction of incision occurred in 1 patient with type 2 diabetes, and the incision healed after debridement operation. The other flaps survived with no flap perfusion related complication. Both donor sites and recipient sites healed by first intention. All patients were followed up 1-14 months (mean, 4 months) with satisfied result of reconstruction. There was no tumor recurrence.ConclusionICG-based fluorescent angiography can reveal the perfusion of the flap in operation instantly and accurately. It should be very helpful to adjusting the strategy in reconstructive operation, especially in the large tissue demanded kinds such as breast reconstruction.

关键词: 吲哚菁绿; 血管造影; 皮瓣血运; 乳房重建

Key words: Indocyanine green; fluorescent angiography; blood infusion of flap; breast reconstruction

引用本文: 周波, 周晓, 李赞, 彭小伟, 杨丽嫦, 吕春柳, 宋达疆, 伍鹏, 彭翠娥. 吲哚菁绿血管造影在自体组织乳房重建中的应用. 中国修复重建外科杂志, 2018, 32(4): 491-494. doi: 10.7507/1002-1892.201708048 复制

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