腔镜辅助切取背阔肌肌瓣在乳腺癌保留乳房手术中的应用

Application of endoscope-assisted latissimus dorsi muscle harvest for correction of deformity following breast-conserving surgery

目的探讨乳腺癌保留乳房手术后即刻在腔镜辅助下经腋窝小切口行背阔肌肌瓣转移整形的临床应用。方法 2008年1月至2009年7月,本科对10例年龄为30～52岁(平均36岁)的原发性乳腺癌患者进行了病灶局部扩大切除后即刻在腔镜辅助下经腋窝小切口切取背阔肌肌瓣转移整形。然后对肿瘤的特性、切除腺体标本的质量、切缘状况、切取背阔肌的切口长度、背阔肌肌瓣大小、切取背阔肌的时间、美容效果和术后并发症进行评估。结果肿瘤直径为2～5 cm(平均3 cm),标本质量为110～215 g(平均150 g),阴性切缘距肿瘤边缘的距离为1～2 cm(平均1.5 cm),切取背阔肌的切口长度10～14cm(平均12cm),背阔肌肌瓣大小为6cm×12cm～8cm×15 cm、切取背阔肌的时间为1～2 h。术后3个月美容效果优3例,良好6例,尚可1例,无外形差的病例。术后所有患者对乳房形态均满意,无严重并发症发生。结论利用腔镜辅助切取背阔肌肌瓣即刻修补乳房缺损,既可缩小手术疤痕,又可减轻手术创伤,是改善保留乳房手术后乳房美容效果的一个好方法。

Objective To explore the clinical application of endoscope-assisted technique in the harvest of latissimus dorsi muscle flap for correction of deformity following breast-conserving surgery. Methods From January 2008 to July 2009, 10 patients with primary breast cancer aged 30--52 years （median 36 years） underwent endoscope-assisted harvest of [atissimus dorsi for immediate breast reconstruction after wide local excision in breast-conserving surgery. Tumor characteristics, resection margin status, muscle flap volume and manipulation duration, postoperative complications and cosmetic outcome were assessed. Results The tumor diameter ranged from 2 cm to 5 cm （mean, 3 cm）. The specimens weighed 110--215 g（mean, 150 g）, and the distance between negative margin and tumor was 1--2 cm （mean, 1.5 crn）. The length of the scar ranged from 10 cm to 14 cm, with mean of 12 cm, The size of the harvested muscle flap varied from 6 cm× 12 cm to 8 cm× 15 cm, and the harvesting duration was 1-2 hours. No serious postoperative complications were found in all patients. Among these 10 patients, excellent outcome was achieved in 3 cases, good in 6 and fair in 1 within 3 months after operation. All patients were satisfied with breast appearance. Conclusion The endoscope-assisted harvesting technique can minimize scar and complications of donor site, decrease operation wound and improve cosmetic outcome after breast-conservation surgery. It is a feasible choice for correcting deformity of the breast.