乳腺癌乳房部分切除术后即刻背阔肌肌皮瓣重建乳房的临床应用

Clinical application of immediate latissimus dorsal myocutaneous flap in breast reconstruction after partial removal of breast

目的探讨Ⅱ期和Ⅲ期乳腺癌新辅助化疗后行乳房部分切除术，并转移同侧背阔肌肌皮瓣（latissimus dorsal myocutaneous flap，LDM皮瓣）进行即刻重建乳房的临床应用及效果。方法18例经粗针抽吸病理组织证实的Ⅱ期和Ⅲ期乳腺癌，经新辅助化疗后进行乳房部分切除术，并转移同侧LDM皮瓣进行重建乳房。术后1个月及放疗完成后1个月对重建乳房外形评分，取平均值为最后分值。采用Kaplan-Meier方法进行生存分析。结果肿瘤经新辅助化疗最大直径由30～55mm缩小至25～45mm。乳房切除标本平均重量为140g（90～220g）。重建乳房93．33％（16／18）评分3分以上。5例背部供区皮下积液（27．78％），2例背部切口裂开（11．11％）。平均随访22个月无局部复发，1例（5．55％）远位转移（骨转移），Kaplan-Meier生存曲线与同期根治术比较无差异。结论联合新辅助化疗的Ⅱ期和Ⅲ期乳腺癌部分乳房切除术后转移LDM皮瓣重建乳房，可提高乳房外形的满意度。

Objective To study the immediate conservative breast surgical reconstruction by transferring the same lateral latissimus dorsal myocutaneous flap （LDM） for the treatment of stage Ⅱ and stage Ⅲ breast cancer, combined with neoadjuvant chemotherapy. Methods Breast cancer patients in stage Ⅱ and Ⅲ with pathological diagnosis by core needle biopsy, had undergone immediate conservative breast reconstruction surgery with transferring the latissimus dorsal myocutaneous （ LDM ）. We scored the reconstructed breast twice at one month after operation and completion of radiation. The final score was decided using the mean value of the twice evaluating score. Kaplan-Meier survival was used to analyze the survival of 18 cases with traditional mastectomy. Results The tumor size ranged from 30 mm to 55 mm before neoadjuvant chemotherapy, and ranged from 25mm to 45 mm after neoadjuvant chemotherapy. The median weight of the tumor specimens in breast conservative operation was 140 g （90 g to 220 g）. Among the 18 patients, 16 cases had more than 3 scores with satisfied cosmetics （93.33 % ）. Dorsal subcutaneous seroma in donation area was observed in 5 of 18 patients （27.78 % ） and dorsal incision dehiscence was observed in 2 of 18 patients ill. 11%）. None of the patients developed recurrence except that 1 patient （5.55%） had distance metastasis （bone metastasis） in a mean 22-months follow-up. The Kaplan- Meier survival curve in breast conservation reconstruction patients had no different from that of traditional mastectomy patients at the same time. Conclusions Immediate conservative breast surgical reconstruction by using the same lateral latissimus dorsal myocutaneous flap is an effective method for stage Ⅱ and stage Ⅲ breast cancer patients combined with neoadjuvant chemotherapy, which can increase satisfactory breast so that cosmetic outcome can be reached.