中国实用外科杂志

中国实用外科杂志

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Ⅰ、Ⅱ期乳腺癌即刻乳房重建153例临床分析

任玉萍，吴乐昊，余    晶，花    卉，朱萌莹，随文文，吴毅平   

  1. 华中科技大学同济医学院附属同济医院整形外科，湖北武汉 430030
  • 出版日期:2015-05-01 发布日期:2015-04-28

  • Online:2015-05-01 Published:2015-04-28

摘要：

目的    探讨 Ⅰ、Ⅱ期乳腺癌的个性化手术方案。方法    回顾性分析2007年2月至2014年1月华中科技大学同济医学院附属同济医院整形外科收治的153例女性Ⅰ、Ⅱ期乳腺癌病人的临床资料，在病人保留乳房外形的要求下，行肿瘤切除或全乳切除+即刻乳房重建手术。结果    153例病人中，行保乳术+即刻乳房重建86例，包括带蒂远端腹直肌肌皮瓣乳房重建30例、带蒂背阔肌肌皮瓣乳房重建56例；保留皮肤的乳腺切除术+即刻乳房重建67例，包括带蒂远端腹直肌肌皮瓣乳房重建21例、带蒂背阔肌肌皮瓣及硅凝胶假体乳房重建43例、扩张器或假体乳房重建术3例。术后乳房形态优良率达93.5%。随访6～60个月，无局部复发及皮瓣坏死等严重并发症；5例发生脂肪液化，6例发生皮下血清肿，经换药引流后治愈；6例出现腹部隆起但无消化道症状；1例因脑转移死亡。结论    即刻乳房重建是Ⅰ、Ⅱ期乳腺癌病人安全理想的选择，个性化的手术方案及带蒂皮瓣技术适合推广。

关键词: 乳腺癌, 即刻乳房重建, 背阔肌肌皮瓣, 远端腹直肌肌皮瓣

Abstract:

Immediate breast reconstruction for Ⅰ or Ⅱ stage breast cancer: An analysis of 153 patients        REN Yu-ping，WU Le-hao，YU Jing，et al. Department of Plastic and Reconstructive Surgery，Tongji Hospital，Huazhong University of Science and Technology，Wuhan 430030，China
Corresponding author：WU Yi-ping，E-mail：usypwu@hotmail.com
Abstract    Objective    To provide individualized treatment to Ⅰ or Ⅱ stage breast cancer patients. Methods    The clinical data of 153 female patients with breast cancer in stage Ⅰor Ⅱ underwent excessive lumptectomy or mastectomy with immediate breast reconstruction surgeries from February 2007 to January 2014 in Department of Plastic and Reconstructive Surgery，Tongji Hospital，Huazhong University of Science and Technology were analyzed retrospectively. Based on patients’ requirements, tumor resection or immediate breast reconstruction following total mastectomy were performed. Results    In 153 patients，86 cases underwent breast conserving surgery（BCS） and immediate breast reconstruction，including 30 cases underwent BCS-T and 56 cases underwent BCS-L. ；67 cases underwent skin sparing mastectomy（SSM） and immediate breast reconstruction，including 21 cases underwent SSM-T，43 cases underwent SSM-L&I and 3 cases underwent SSM-E/I. Out of 153 patients，the reconstructed breast presented good shape and 93.5% of the patients were consent with the aesthetic outcome. The follow-up period varied from 6 months to 60 months with only one patient died from tumor metastasizing in the brain，no local recurrence and no graft loss. Fat necrosis occurred in 5 patients and 6 patients had subcutaneous seroma，which resolved after proper draining. Six patients had visible protuberance in the abdomen but did not cause any gastrointestinal symptoms. Conclusion    Immediate breast reconstruction is a safe and ideal treatment for patients with Ⅰ or Ⅱ stage breast cancer. Individualized surgical procedures and pedicled-flap based breast reconstruction have high applicability.

Key words: breast cancer, immediate breast reconstruction, latissimus dorsi flap, distal transverse rectus abdominis myocutaneous flap