乳腺癌保留皮肤全乳切除一期乳房重建129例临床分析

A retrospective study of 129 cases with immediate breast reconstruction after skin-sparing mastectomy for breast cancer

目的探讨乳腺癌保留皮肤全乳切除（SSM）联合一期乳房重建（IBR）的安全性、适应证、美容效果及其对辅助治疗的影响。方法对1999年10月至2007年5月共129例接受SSM＋IBR手术的乳腺癌患者进行回顾性分析。采用背阔肌或背阔肌联合假体、带蒂横行腹直肌肌皮瓣等方法行乳房重建。结果平均住院18．6d，术后首次化疗开始时间平均为术后第5．2天。假体包囊挛缩11例（11／63，17．5％），背部供区血清肿24例（24／99，24．2％），腹直肌肌皮瓣或腹壁下动脉穿支皮瓣部分坏死或硬结9例（9／28，32．1％）。未接受放疗患者对重建乳房外观的可接受度为89．7％，高于接受放疗患者的68．2％（P〈0．01）。随访2～73个月，中位随访11个月。局部复发5例，远处转移7例。结论SSM＋IBR对于0—Ⅱa期乳腺癌患者是安全的，能同时满足肿瘤治疗及形体美容的要求。放疗对于重建乳房的外观有一定的负面影响，对于需要术后放疗的患者，可以考虑延期或者延期-即时乳房重建。

Objective To evaluate the oncologic safety, indications and aesthetic results for skinsparing mastectomy（SSM） and immediate breast reconstruction（IBR）. Method One hundred and twentynine breast cancer patients treated by SSM ＋ IBR from October 1999 to May 2007 were reviewed. Reconstructive techniques included latissimus dorsi flaps （38 patients）, implants only （2 patients）, latissimus dorsi flaps plus implants （61 patients ）, pedicled transverse rectus abdominis myocutaneous （TRAM） flaps （ 25 patients ） and deep inferior epigastric artery perforator （ DIEP ） flaps （ 3 patients ）. Aesthetic results were judged by patients＇ self-evaluation. Results Mean duration of hospitalization was 18, 6 days. Time of first chemotherapy was 5.2 days after operation. Eleven patients （ 11/63, 17. 5% ） developed capsular contracture and 24 patients （24/99, 24. 2% ） developed seroma in the donor site. Nine patients （9/28, 32, 1% ） developed partial fat necrosis in TRAM and DIEP flaps. The satisfaction with the aesthetic results of the reconstructive breast was significantly lower in irradiated patients than non-irradiated ones, Median follow-up time was 11 months, Five patients developed local recurrence and 7 patients with metastasis. Conclusions SSM with IBR can be used for the 0 to Ⅱ a stage breast cancer patients, with surgical oncologic and aesthetic satisfaction. Radiotherapy has an adverse effect on the reconstructive breast. Delayed or delayed-immediate reconstructions are recommended for patients indicated to postoperative radiotherapy.