乳腺癌改良根治术后乳房缺如Ⅱ期再造

Breast reconstruction after reforming radical correction of mammary cancer

目的探讨乳腺癌改良根治术后末即刻行乳房再造而造成患侧乳房缺如的患者，进行Ⅱ期再造，使患者恢复乳房美观外形的一种手术方法，进一步探讨其对患者生活质量的干预程度。方法选择乳腺癌根治术后1年以上，局部未复发、远侧未转移、有迫切再造愿望的患者，经腋下切口或原切口将皮肤扩张器植入缺损侧胸壁皮下，待皮肤扩张到所需容积后，将假体自胸大肌、胸小肌间植入，恢复乳房美观外形，完成Ⅱ期再造。结果自1998年至2003年共完成此类手术43例，随访2年，所植假体无破漏、无移位，皮肤无挛缩，外观形态优良。结论本手术方法简单、损伤小，手术适应证范围宽，既恢复了患者的乳房形态，又避免了因乳房再造所采用自身组织（腹直肌或背阔肌或臀部肌瓣）填充所带来的二次损伤，患者容易接受，使其术后的生活质量较术前明显提高。

Objective To study an operation technic of breast reconstruction in the treatment of operative defect of mammary cancer, and further analyse the influence degree of quality of life to patients. Methods To choose the patients whose part was no recidivation, distally aversion was not found and want to improve the quality of life after one year later by reforming radical correction of mammary cancer. Breast was reconstructed using prothesis embedding via between ectopectoralis and entopectoralis after implanting derma - extender under the subcutaneously until the cutaneous covering volume obtain requirement. Results Forty -three cases had been fellowed up in 2 years. All prothesis had no defeat, displace and leakage, skin had no contra, and external appearance showed excellent. Conclusion The skill showes simple, lower - injure, and eury - indication. It can recover breast morphous and improve the quality of life greatly, moreover evade damage again because of padding autologous tissue（ rectus abdominis, latissimus dorsi muscle ,or stern muscle flap）.