乳腺癌术后一期乳房再造

Immediate breast reconstruction after mastectomy of breast cancer

背景与目的：乳房再造使乳腺癌全乳切除患者重获完整的乳房外形。本文介绍乳腺癌术后应用带蒂背阔肌肌皮瓣联合或不联合假体和带蒂横向腹直肌肌皮瓣（TRAM）行一期乳房再造的经验，并探讨适合中国乳腺癌患者的乳房再造方式。方法：2000年1月-2005年7月，74例乳腺癌患者乳房切除后，应用背阔肌肌皮瓣或带蒂TRAM行一期乳房再造。结果：再造手术均取得成功，背阔肌肌皮瓣再造62例（83．8％），其中联合假体13例、带蒂TRAM再造12例、联合假体1例。经过2～66个月随访，局部区域复发率4．1％。患者满意度高，可接受度96％。而且这两种自体再造方式在是否需要联合假体上没有差别（P=0．440）。结论：乳腺癌术后一期乳房再造能同时满足肿瘤治疗和形体美容的要求，提高患者生活质量，背阔肌肌皮瓣再造对中国女性适用性好，值得推广。

Background and purpose： Breast reconstruction makes it possible for the patients who have received mastectomy to regain contour of breast. This report introduced the experience of immediate breast reconstruction with autologous tissue （latissimus dorsi myocutaneous flap with or without implants and transverse rectus abdominis myocutaneous flap, TRAM） after mastectomy for breast cancer, and discussed the suitable reconstruction modalities for Chinese patients. Methods： From Jan. 2000 to Jul. 2005, 74 patients （median age 39） received immediate breast reconstruction with autologous tissue （62 by latissimus dorsi myocutaneous flap with 13 implants; 12 by pedicled TRAM flap with 1 implant） after mastectomy due to breast cancer, most of whom were 0-Ⅱ stage. Results： All reconstructions were successful and locoregional recurrence was 4.1% by follow-up of 2-66 months. Aesthetic results were judged as good or fair in 96% patients. Latissimus dorsi myocutaneous flap showed no more need for implants than the pedicled TRAM flap modality （P = 0.440, Fisher exact test）. Conclusions： Immediate autologous tissue reconstruction regains the natural and symmetric appearance of breast without increased local recurrence. Latissimus dorsi myocutaneous flap reconstruction is appropiable for Chinese women as well as pedicled TRAM flap.