两种补片修补TRAM皮瓣切取后腹壁缺损的临床效果比较(1)
 |
| 第1页 |
参见附件。
[摘要]目的：比较聚丙烯网片与膨体聚四氟乙烯补片修补TRAM皮瓣切取后腹壁缺损的有效性及安全性。方法：回顾性分析85例游离TRAM皮瓣切取术后腹壁缺损的修补，比较两组患者术后并发症的发生率。结果：两组患者均无腹壁疝发生；聚丙烯网片组患者腹壁膨出率为6.3%，膨体聚四氟乙烯补片组为5.7%，无显著性差异；膨体聚四氟乙烯补片组术后感染率及积血积液率略高于聚丙烯网片组，无显著性差异；聚丙烯网片组患者术后疼痛不适及异物感发生率为34.4%，高于膨体聚四氟乙烯组的3.8%，差异具有统计学意义。结论：两种补片对于修复TRAM皮瓣切取后腹壁缺损都是有效的，膨体聚四氟乙烯补片更佳。
[关键词]聚丙烯网片；膨体聚四氟乙烯补片；TRAM皮瓣；腹壁缺损
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)05-0713-03
Comparison of PPM and e-PTFE mesh for repairing abdominal wall defect after harvesting the free TRAM flap
YANG Hong-yan,ZHAO Yu-ming,YAN Xiao-qing,ZENG Wei,LI Dan,LIU Dai,WANG Bai-shi,ZHANG Yuan-wen,XU Jun
(Department of Plastic Surgery, Clinical Division of Surgery,Chinese PLA General Hospital,Beijing 100853,China)
Abstract: Objective To compare the efficacy and safety of polyproylene mesh (PPM) and expanded polytetrafluoroethylene (e-PTFE) mesh for repairing abdominal wall defect after harvesting the free TRAM flap. Methods 85 cases of abdominal defects repaired with PPM or e-PTFE were retrospectively surveyed. Complications of abdominal wall were compared between two groups. Results None of hernia was occurred in both groups,abdominal wall bulging rates were around 6.3% in PPM group and 5.7% in e-PTFE group,with no significant difference.E-PTFE mesh had more infections and seromas than PPM,but with no significant difference. 34.4% of patients in PPM group felt postoperative discomfort and pain which were much higher than those in e-PTFE group(3.8%). Conclusions PPM and e-PTFE mesh were effective for repairing abdominal wall defect after harvesting the free TRAM flap while E-PTFE mesh maybe better.
Key words:PPM;e-PTFE;TRAM flap;abdominal defect
横行腹直肌肌皮瓣(transverse recutus artery myocutanous flap, TRAM)因其组织量充足、质地柔软、血供充沛而广泛应用于皮肤软组织缺损的修复，尤其适用于乳房再造，被称为乳房再造方法的金标准。然而，皮瓣切取后遗留的腹壁缺损有可能发生腹壁膨出、腹壁疝以及腹肌无力等并发症，目前应用合成补片修补腹壁被认为是一种简单有效的方法。笔者2008年1月至2011年底，分别应用聚丙烯网片(polyproylene mesh, PPM)及膨体聚四氟乙烯补片(expanded polytetrafluoroethylene, e-PTFE)修复TRAM皮瓣切取后腹壁缺损共85例，通过随访并进行临床总结及对比性分析。
1 资料和方法
1.1 临床资料：本组患者共85例，应用单蒂游离TRAM皮瓣行乳腺癌术后乳房再造术，分别来自北京协和医院、中国人民解放军总医院、北京肿瘤医院，术者均为通讯作者。皮瓣切取后腹直肌及腹壁前鞘缺损，大小为5～7.5cm×5～8cm，应用人工合成补片进行修复，其中聚丙烯网片(强生公司Prolene网片)32例，膨体聚四氟乙烯补片(戈尔公司MycroMesh补片)53例，术后随访时间为3～24个月，平均为4.7个月。
1.2 手术方法:两种补片修复腹壁缺损时，缝合固定方法相同。
1.2.1 皮瓣设计：在下腹部以一侧腹壁下动脉为蒂设计皮瓣呈梭形，皮瓣上缘位于脐水平，皮瓣宽度根据组织需要量以及下腹张力而决定。
1.2.2 皮瓣切取：按设计切口线切开皮瓣四周皮肤、皮下组织，在腹外斜肌腱膜浅层由外向内掀起皮瓣，内侧至腹白线，外侧至半月线。切开腹直肌前鞘，两侧分别保留1cm左右前鞘组织，以便缝合补片。由外向内将腹直肌从后鞘表面游离出来 ......
您现在查看是摘要介绍页，详见PDF附件(2486kb)。