改良双环法行乳房巨大肿瘤切除成形术

Modified round block technique in removal of huge breast tumor and mammoplasty

目的 探讨一种既能完整切除乳房巨大肿瘤,又能保持乳房功能和良好外形的手术方法 .方法 在传统双环法基础上,根据乳房肿瘤的大小及乳头下垂的程度,设计不同形状的外环及乳房外侧S形切口线,削除两环之间皮肤的表皮,沿乳房外侧S形切口线切开皮肤、皮下组织,直达瘤体包膜,沿包膜表面完整剥离肿瘤,可见遗留一个巨大的乳房皮下腔隙,充分利用去表皮的真皮脂肪瓣或真皮脂肪乳腺瓣填充肿瘤切除后的腔隙,重建乳房形态.结果 5例乳房巨大肿瘤,术后均维持了较好的形态和功能,无1例发生乳头乳晕感觉障碍和坏死,切口愈合良好.最长随诊2年,未见瘤体复发.结论 改良的双环法行乳房巨大肿瘤切除成形术,手术设计灵活,方法 简单,术后乳房外形良好,瘢痕轻,患者满意率高.

Objective To explore a surgical method which can not only remove the enormous breast tumor entirely, but also maintain the breast function and obtain satisfactory shape.Methods On the basis of traditional round block technique, we designed different form＇s outer ring and breast lateral Sshaped incision line according to the size of breast tumor and the degree of the papillae ptosis, trimmed away the epidermis between the two circles, a S-shape skin incision along lateral border of breast was made; after reaching to the capsule of tumor, we stripped off the tumor entirely along capsule surface, a large breast cavus subdermalis remained, and then made full use of the dermal-fat flap or dermal-fat breast flap to fill the cavity after tumor removal so that the shape of breast was reconstructed. Results All of the 5 cases maintained the breast function and satisfactory shape after surgery, no sensory obstacle and necrosis occurred in the papillae and areola, and the wound reached good healing. Up to 2 years of follow-up there was no recurrence of tumor was found. Conclusions The modified round block＇ technique is an i-deal method for removal of a huge breast tumor. The design is nimble and simple, and postoperative breast shape is satisfactory with light scar formation.