乳癌术后不同乳房再造术式的临床应用

CSnical breast reconstruction with various methods

目的 探讨适合乳癌术后各种乳房再造术式的适应证。方法 对我院2003至2005年收治的44例、45只乳癌术后乳房再造的患者，根据不同情况分别采用扩张器，假体置入（5只）、背阔肌肌皮瓣＋假体置入（13只）、背阔肌肌皮瓣（3只）、DIEP皮瓣（6只）、单蒂TRAM瓣（10只）及劈开的双蒂TRAM瓣（8只）等方法进行乳房再造，分析各手术方法的适应证。结果 应用皮瓣乳房再造40只，皮瓣全部成活；1只应用扩张器，假体乳房再造术后，注射壶部表皮坏死；1只应用背阔肌＋假体乳房再造术后半年出现假体破裂伴局部感染；1只应用DIEP乳房再造术后，出现皮瓣下积液；2只部分皮瓣坏死。术后随访3个月至半年，医生及患者对乳房形态均较满意。所有应用腹部皮瓣的患者均无腹壁疝发生。结论 6种乳房再造技术基本满足了我国女性乳癌术后各个时期各种条件再造乳房的要求，整形外科技术的改进以及新材料的应用扩大了乳房再造的适应证。

Objective To investigate and clarify the indications of breast reconstruction after mastectomy with various methods. Methods A clinical analysis was made, based on 44 patients with the 45 breasts who had received breast reconstruction, after mastectomy in our hospital from 2003 to 2005. The methods of breast reconstruction included in tissue expander/implant（5 cases） ,implants covered by latissimus dorsi flap（ 13 cases）, latissimus dorsi flap along（3 cases）,DIEP flap （6 cases）, TRAN flap（ 10 cases）and splid double-pedicle TRAM flap（8cases）. Resdts All of the flaps survived well in total 40 patients（40 breasts） who were used a flap for breast reconstruction. Superficial skin necrosis occurred in 1 case with the method of tissue expander/implant; rupture of breast prosthesis and infection occurred in 1 ease with the technique of implant with a latissimus dorsi flap; subcutaneous seroma occurred in 1 case with the method of DIEP flap;partial flap necrosis occurred in 2 cases with the method of TRAM flap . By the follow-ups of 3 - 12 months, the reconstructed breasts were well-shapped and there were no complications such as abdominal hernia. Conclusions These 6 methods for breast reconstruction achieved the satisfactory results for the requirement of breast reconstruction in Chinese women. With the development of plastic surgery technique, the indications of breast reconstruction were enlarged.