摘要目的 探讨腹壁上动脉主干胸廓内动脉的走行,从影像学角度分析截断下位肋软骨,进行带蒂横行腹直肌肌皮瓣用于乳房再造的可行性.方法 对30例患者进行腹部血管CT造影,以观察并记录下述指标:①胸廓内动脉到胸骨正中线的距离;②胸廓内动脉分出腹壁上动脉及肌膈动脉分支点在第5～7肋及肋间隙出现的数目,并定位分支点;③定位腹壁上动脉穿越腹直肌的分支点.结果 ①第4～6肋间隙,左胸廓内动脉距胸骨正中线的平均距离为1.66—2.34 em,右胸廓内动脉距胸骨正中线的平均距离为1.55—2.29 cm;②位于第6肋间隙的分支点最多;③腹壁上动脉及其较大分支共有235个分支点.结论 对腹壁上动脉主干胸廓内动脉走行的影像学观察结果表明,截断下位肋软骨行带蒂横行腹直肌肌皮瓣的乳房再造具有可行性,且对于延长皮瓣蒂部以及再造乳房具有重要意义.

abstractsObjective To investigate the distribution of the internal mammary artery and its branches by the multi-slice spiral CT angiography,and to explore the feasibility of transferring pedicled transverse rectus abdomials myocataneous (TRAM) flap for breast reconstruction through resection of inferior costicartilages.Methods 30 female patients received abdominal CT angiography.①The distance between internal mammary artery and the sternum midline were recorded; ② The position and the numbers of branches from bilateral internal mammary arteries at the level of 5th,6th,7th rib was observed; ③ The points where the superior epigastric artery gets through the rectus abdominis muscle were located.Results ① The average distance between left internal mammary artery to the sternum midline is from 1.66 cm (0.62-2.39 cm) to 2.34 cm (0.69-3.36 cm) at the level from 4th to 6th intercostal space.The average distance between right internal mammary artery to the sternum midline is from 1.55 cn (0.66-2.29 cm) to 2.29 cm(0.73-3.67 cm) at the level from 4th to 6th intercostal space; ② The number of branches is the most at the level of 6th intercostal space; ③ There are 235 branches in the superior epigastric artery.Conclusions This imaging study of internal mammary artery explores the feasibility of transferring pedicled transverse rectus abdominals myocataneous flap for breast reconstruction.It has important significance in the breast reconstruction using TRAM flap with lengthened pedicle.