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目的:探讨腹部皮瓣乳房再造术后并发症及相关危险因素。方法:回顾性分析2011年1月至2022年4月天津医科大学肿瘤医院乳房再造科行腹部皮瓣乳房再造484例患者的临床资料。结果:484例患者中95例（19.6%）出现术后并发症，其中15.5%发生皮瓣并发症，5.2%发生供区并发症，脂肪坏死是发生率最高的并发症（11.9%），通过技术改进脂肪液化率较前大幅下降（1.7%比7.0%）。单因素分析结果表明，再造术式、新辅助化疗史、BMI、吸烟史均与术后并发症有关（ χ2=21.088， P<0.001； χ2=4.385， P=0.036； χ2=14.784， P=0.018； χ2=19.015， P=0.048），再造时机及术式均与非计划再次手术有关（ χ2=7.316， P=0.007； χ2=17.167， P<0.001），再造时机、放疗时序均与修整手术有关（ χ2=40.785， P<0.001； χ2=18.602， P<0.001）；多因素分析结果表明，腹壁下动脉穿支皮瓣、吸烟史是皮瓣坏死的独立危险因素（ OR=0.084，95% CI：0.022~0.325， P<0.001； OR=41.623，95% CI：3.241~534.569， P=0.004）。 结论:腹部皮瓣乳房再造术后并发症与多种因素有关，术前应详细评估手术风险，制定个性化方案。

Objective:To study the postoperative complications and its risk factors in patients undergoing breast reconstruction with abdominal flaps.Methods:The clinical data of patients undergoing breast reconstruction with abdominal flaps at Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital from Jan 2011 to Apr 2022 were reviewed.Results:Postoperative complications occurred in 95 of 484 patients (19.6%), 15.5% had flap complications, 5.2% had donor-site complications, and fat necrosis was the most common complication (11.9%). The rate of fat liquefaction decreased significantly through technical improvement (1.7% vs. 7.0%); By univariate analysis, there were statistically significant differences among the groups by reconstructive type, neoadjuvant chemotherapy, BMI, smoking history ( χ2=21.088, P<0.001; χ2=4.385, P=0.036; χ2=14.784, P=0.018; χ2=19.015, P=0.048). Unplanned reoperation statistically related to the timing of reconstruction, and reconstructive type ( χ2=7.316, P=0.007; χ2=17.167, P<0.001). Revision surgery significantly related to the timing of reconstruction and timing of radiation ( χ2=40.785, P<0.001; χ2=18.602, P<0.001);By multivariate analysis, deep inferior epigastric perforator flap, smoking history were independent risk factors for flap necrosis ( OR=0.084, 95% CI:0.022-0.325, P<0.001; OR=41.623, 95% CI:3.241-534.569, P=0.004) . Conclusions:Complications after breast reconstruction with abdominal flaps are related to many factors. The surgical risks should be carefully evaluated and personalized plan should be formulated before surgery.