即刻及延期乳房再造方法的选择

A selection of methods for immediate and delayed breast reconstruction

目的回顾总结乳腺癌根治术后应用单纯假体植入、Becker 可扩张假体植入和单蒂腹部横形腹直肌肌皮瓣(TRAM)移植、扩大背阔肌肌皮瓣(ELDF)移植乳房再造术的经验,探讨手术的适应证、方法和效果。方法自2002年7月至2005年10月,共67例患者进行了乳腺癌根治术后乳房再造术。即刻乳房再造56例:单纯假体植入38例、Becker 可扩张假体植入16例、单蒂 TRAM 移植2例。延期乳房再造11例:单蒂 TRAM 移植6例、ELDF 移植4例、Becker 可扩张假体植入1例。结果手术效果满意,优良率超过90%。5例患者出现轻微并发症:皮瓣局灶性坏死2例,保留的乳头乳晕部分坏死1例,血清肿2例。结论单纯假体植入用于即刻乳房再造,适用于乳房较小、行保留皮肤的乳腺癌根治术后的患者,不宜用于延期乳房再造;可扩张假体植入即刻乳房再造适用于乳房较大或改良乳腺癌根治术的患者,同时可扩张假体植入延期乳房再造可用于皮肤、肌肉保留较好的乳腺癌根治患者;TRAM 和 ELDF 皮瓣移植乳房再造是自体组织移植,其安全性高,可用于即刻和延期乳房再造。

Objective To investigate the surgical methods, indications and effects of postmastectomy breast reconstruction in 67 consecutive patients. Methods From July 2002 to October 2005, 67 patients received postmastectomy breast reconstructions. Immediate breast reconstructions were performed using full-size implants in 38 cases, Becker expandable implants in 16 cases, unilateral pedieled transverse rectus of abdominis musculocutaneous （TRAM） in 2 cases. Delayed breast reconstruction were carried out in 6 cases with unilateral pedicled TRAM flaps, 4 cases with extended latissimus dorsi musculocutaneous flap（ EDLF）, one case with Becker expandable implant. Results Of the patients, more than 90% were satisfied with the results. Minor complications were recorded in 5 patients, including small local skin necrosis, partial necrosis of nipple-areola complex preserved and seroma formation. Conclusions Full-size implant breast reconstruction is ideal for slender, small-breast women undergoing immediate breast reconstruction after skin-sparing mastectomy, but not suitable for delayed breast reconstruction. Expandable implants can be used for immediate breast reconstruction in patients with large breast or those who received modified mastectomy and also can be used for delayed breast reconstruction in patients with well-preserved skin and muscle. TRAM or ELDF flap for breast reconstruction is a useful procedure with advantages of autologous tissue and excellent results, both are suitable for immediate and delayed breast reconstruction.