乳腺癌保乳手术的体会

Methods of maintaining breast appearance by conserving surgery in breast cancer patients

目的 总结和探讨乳腺癌保乳手术保持乳房良好外形 ,在术前、术中和术后应注意的问题。方法 3 7例患者接受了乳腺癌保乳手术。术后从乳头外观、双乳头水平差距、双乳头距同侧腋前线垂直距离之差距和瘢痕对乳房外形影响等四个方面的量化标准 ,评估保留乳房的外形美观效果。四项指标积分≥ 2 1分为优 ,13～ 2 0分为良 ,<13分为差。结果 术后保留乳房外形优良者 3 0例 ( 81.1% ) ,乳房外形较差者 7例 ( 18.9% )。常见问题是因切口瘢痕致乳房变形、乳头歪斜、乳头不自然挺立 ,以及与对侧乳头水平高度差距明显。结论 术前认真设计手术切口、术中注意术区皮瓣和保留乳腺组织的彻底游离以及切除、缝合技巧 ,术后切口包扎时注意避免压迫乳头等 。

Objective To discuss the methods and problems of conserving surgery for maintaining breast appearance of breast cancer patients.Methods Thirty-seven patients underwent breast conserving surgery and breast appearance after operation was evaluated for mammillary shape,plane difference of bilateral mammilla,the distance difference of bilateral mammillary to anterior axillary line,and scar influence.Results Thirty patients (81.1%) got the satisfactory breast appearance after surgery and the remaining 7 (18.9%) got poor appearance.The main problems included breast distortion by scar,mammillary deflection,unnatural erected mammilla,and significant plane difference of bilateral mamillary.Conclusion Serious preoperative incision design, attention to skills of free skin flap and breast tissue during operation,and avoiding postoperative press on mammilla would beneficial to maintain the better breast appearance.