乳腺癌改良根治与乳房重建术的临床研究

Clinical research of nippleareola preserved mastectomy and one stage breast reconstruction with rectus abdominis musculocutaneous flaps

探讨乳腺肿瘤行保留乳头乳晕的乳房切除、一期腹直肌肌蒂皮瓣乳房重建术的可行性。方法利用腹直肌肌蒂皮瓣轴心血供可靠，取材量充分，可塑性强等优点，将乳腺癌改良根治术与乳房重建术有机的结合，使重建乳房切口隐蔽，并保留乳头乳晕，达到重建乳房裸视下逼真。结果２１例患者，１８例采用横梭形皮瓣，３例采用纵梭形皮瓣乳房重建。１６例保留乳头乳晕。重建乳房术后客观评价效果优良和尚好者达９０．５％；主观评价优良和尚好者达９５．２％。随访３年以上１３例，随访５年以上９例，３年无瘤生存率为１００％（１３／１３）。５年无瘤生存率为８８．９％（８／９）。结论保留乳头乳晕的乳房切除、一期腹直肌肌蒂皮瓣乳房重建术是治疗Ⅰ、Ⅱ期乳腺癌安全可行的方法，值得推荐应用。

Objective To discuss the method for nipple areola preserved mastectomy with one stage breast reconstruction in cancer surgery. Methods Because of the merits of sufficient blood supply and plasticity of rectus abdominis musculocutaneous flap, we used one stage breast reconstruction after modified radical mastectomy. The incision line was covered and the nipple areola was preserved. The reconstructed breast was naturally in contour. Results 21 cases were treated from 1990 to 1995, and 18 of them received horizontal rhombus shaped rectus abdominis musculocutaneous flaps and 3 longitudinal rhombus flaps for breast reconstruction. Nipple areola was preserved in 16 cases. Objective evaluation after operation showed that the excellent and satisfied rate reached to 90.5%; and subjective evaluation showed that the excellent and satisfied rate reached to 95.2%. Thirteen cases have been followed up for 3 years, and 9 for 5 years. Three year survival rate was 100%(13/13), and 5 year 88.9%(8/9). Conclusion The method is recommendable for the treatment of stage Ⅰ～Ⅱ breast cancer