乳腺癌根治术后部分筋膜法TRAM瓣I期乳房再造术临床应用

目的探讨乳腺癌根治术后部分筋膜法横行腹直肌肌皮瓣(TRAM)乳房再造的手术方法的临床应用。方法对32例乳腺癌根治术患者行部分筋膜法TRAM瓣I期乳房再造术。结果32例中,左侧腹直肌蒂者16例,右侧蒂14例,双侧蒂1例。术后所有病例的TRAM瓣均存活,仅1例发生皮瓣边缘坏死。再造乳房与对侧基本对称26例,不对称6例中,4例为对侧乳房中度以上下垂,2例为再造乳房偏小。24例乳房下皱褶与健侧相应,有对称感;6例乳房下极偏低。供区愈合延迟、线头反复排出3例、供区切口旁脂肪液化2例、供区瘢痕增生5例等术后并发症。结论部分筋膜法TRAM瓣再造乳房术式有较好的可操作性,能降低术后腹壁并发症发生率,值得推广应用。

Objective To discuss the clinical application of partial fascia method transverse rectus abdominis musculocutaneous flap （TRAM） I-stage breast reconstruction surgery after radical mastectomy. Methods Thirty-two cases of radical mastectomy patients were operated with partial fascia method TRAM I-stage breast reconstruction surgery. Results In the 32 cases, there were 16 cases of the left rectus abdominis pedicle, 14 cases of the right pedicle, 1 cases of bilateral pedicle. All patients＇ TRAM flap were survived after operation. Only 1 case happened the flap edge necrosis. 26 cases of reconstruction breast were basic symmetry with the contralateral breast. In the 6 cases of dissymmetry, 4 cases contralateral breast were more than moderate ptosis, 2 cases of reconstruction breast were small. 24 cases of the fold under the breast were corresponding with the contralateral side. 6 cases of the breast lower pole were low. 3 cases of donor site were delayed healing and thread repeatedly eliminated. 2 cases of adjacent donor site incision were fat liquefaction. 5 cases of donor site were scar proliferation. Conclusion Partial fascia method TRAM breast reconstruction surgery has better manipulability. It can reduce the incidence of postoperative abdominal complications. It is worthy of wide application.