横行腹直肌肌皮瓣应用于乳腺癌术后即时乳房再造的临床研究

Immediate breast reconstruction with TRAM flap after radical mastectomy

目的探讨横行腹直肌肌皮瓣(TRAM)应用于乳腺癌术后即时乳房再造的临床研究。方法选取2016年4月至2018年4月间广东省高州市人民医院收治的行TRAM乳房重建术治疗的20例乳腺癌患者为TRAM组,另同期选取采用背阔肌肌皮瓣再造术(LDM)治疗的20例乳腺癌患者为LDM组。比较两组患者乳房再造术后外观、乳房体积变化和术后并发症。结果两组患者术中出血量、手术时间、住院时间和住院总费用比较,差异无统计学意义(P<0.05)。TRAM组患者乳房重造后外观评价优良率为95.0%,LDM组为90.0%,两组组间比较,差异无统计学意义(P>0.05)。重复测量方差分析显示,两组患者不同时点乳房重建后乳房体积比较,差异有统计学意义(P<0.05)。且术后1、3、6、12个月,两组患者的乳房体积比较,差异无统计学意义(P>0.05)。两组患者术后伴有局部积液和血肿等并发症,两组患者乳房重造后并发症总发生率比较,差异无统计学意义(P>0.05)。结论乳腺癌术后即时TRAM乳房再造方法术中出血少,再造乳房外观较佳,且术后并发症少,对乳腺癌根治术后患者生活质量的提高具有积极意义。

Objective To study the efficacy of immediate breast reconstruction with Transverse rectus abdominis musculocutaneous(TRAM)flap after radical mastectomy.Methods Twenty patients with breast cancer who underwent breast reconstruction with TRAM flap at Gaozhou People’s Hospital from April2016 to April 2018 were included in the TRAM group,and another 20 patients who underwent latissimus dorsi myocutaneous(LDM)flap for breast reconstruction were included in the LDM group.The differences in postoperative appearance,breast volume and postoperative complications were compared between the two groups after breast reconstruction.Results There were no statistically significant differences in intraoperative blood loss,operation time,length of hospital stay and overall hospital expenses between the two groups(P>0.05).The excellent and good rate of breast appearance was 95.0%in the TRAM group and 90%in the LDM group after treatment(P>0.05).Variance analysis of repeated measurement showed that difference in breast volume after breast reconstruction between the two groups at various time points was statistically significant(P<0.05).There was no significant difference in breast volume between TRAM group and LDM group at 1,3,6 and 12 months after the surgery(P>0.05).The other two groups of patients were accompanied by local effusion,hematoma and other postoperative complications,without necrosis of skin flap or abdominal wall hernia.Conclusion Immediate breast reconstruction with TRAM after radical mastectomy reduces intraoperative blood loss,makes good appearance of reconstructed breasts,and improves quality of life in patients with breast cancer after radical mastectomy.