乳腺癌切除术后乳房再造

Breast reconstruction after masteetomy for breast cancer

目的探讨乳腺癌切除术后乳房再造的方法及时间。方法总结30例不符合保乳条件的乳腺癌病例，乳房切除术后假体置入乳房再造16例，下腹部横行腹直肌肌皮瓣（TRAM瓣）乳房再造10例，背阔肌肌皮瓣乳房再造4例。其中即刻乳房再造27例，延期乳房再造3例。结果16例假体置入乳房再造术后外观评价均为良，未出现术后并发症。10例TRAM瓣乳房再造术后发生皮瓣部分坏死2例，腹壁疝1例，术后外观评价7例为良，2例为较好，1例为差。4例背阔肌肌皮瓣再造术后外观评价为良。结论乳房再造术是乳腺癌综合治疗不可忽视一部分，对于有强烈的保乳愿望，而又不符合保乳条件的患者，乳房再造术是一种较好的选择。即刻乳房再造优于延迟乳房再造。乳房再造的方法选择要因人而异。局部晚期乳腺癌患者可以选择性进行即刻乳房再造术。

Objective To explore the technique of breast reconstruction after mastectomy. Methods 30 cases of patients with breast cancer who were not suitable for breast conservative surgery were summarized. Among them, immediate breast reconstruction with prosthetic implants after mastectomy was used in 16 patients, transverse rectus abdominis museulocutaneous flap （TRAM flap） in 10 patients, and latissimus dorsi musculocutaneous flap in 4 patients. There were 27 patients who underwent immediate breast reconstruction, while 3 patients underwent delayed breast construction. ResuLts The appearance was good in 16 cases of breast reconstruction with prosthetic implants and no complications were found. Two out of the ten patients who had the transevarse rectus abdominis musculocutaneous flap （TRAM flap） breast reconstruction had partly necrosis of skin flap, and one lateral ventral syndrome. The appearance of the 7 cases after the TRAM flap breast reconstruction evaluated well, 2 cases moderate, and one case less satisfactory. The appearance of 4 patients who had breast reconstruction with latissimus dorsi musculocutaneous flap evaluated well. Conclusion Breast reconstruction is an important part of combined therapy for the breast cancer, especially for the patients who have strong desire to conserve breast, while incompetence for breast conserving surgery. In such a case breast reconstruction is a good choice. Immediate breast reconstruction is better than delayed breast construction. The appropriate method of breast reconstruction depends on each individual patient. Patients with locally advanced breast carcinoma can selectively choose immediate breast reconstruction.