两种补片修补TRAM皮瓣切取后腹壁缺损临床效果比较.doc

两种补片修补TRAM皮瓣切取后腹壁缺损临床效果比较[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