经皮下背阔肌肌瓣转移即刻乳房再造研究

Immediate breast reconstruction with partial latissimus dorsi muscular flap after subcutaneous mastectomy

目的探讨乳腺癌经皮下全乳腺体切除术后,采用部分背阔肌肌瓣转移、联合假体即刻乳房再造的临床价值。方法收集北京协和医院和天津医科大学附属肿瘤医院2006年1月至2007年1月采用经皮下全乳腺体切除术后带状背阔肌转移、联合假体即刻乳房再造术的12例乳腺癌病人的临床资料,分析该术式的特点及适应证。结果术后2例出现皮瓣下血清肿,经抽吸1周后痊愈。12例病人均接受化疗。最长随访1年,医生及病人对乳房形态均较满意。结论该术式简单,安全,手术时间短,效果良好,适用于肿瘤最大直径<3cm,肿瘤距离乳晕外缘有一定的距离,不适合保乳治疗,或预计保乳术后难以达到良好美学效果的病人。

Objective To explore a new method of immediate breast reconstruction （IBR） after subcutaneous mastectomy. Methods The clinical data of 12 cases of breast cancer performed IBR with a strip of latissimus dorsi muscle and an implant after subcutaneous mastectomy between January 2006 and January 2007 in Peking Union Medical Hospital and Tianjin Tumor Hospital were analyzed. A introduce was made on the methods of IBR. The indication of the procedure was evaluated. Results Subcutaneous seroma occurred in 2 cases, and they healed after 1 weekly pump treatment. All patients received chemotherapy after operation routinely. They all satisfied with their new breasts. The longest follow-up was 1 year, doctors and patients were all satisfied with the cosmetic outcome of IBR. Conclusions IBR technique is safe, simple, and effective. It can shorten operation time. The indication of IBR is that patients are evaluated not to be adapted to breast save therapy, or not to expect an aesthetic outcome aftdr a breast save therapy, and tumor site is 2cm from the NAC and no more than 3 cm.