乳腺癌改良根治术后一期乳房再造的临床应用

Skin-sparng mastectomy and immediate breast reconstruction for breast cancer

目的探讨乳腺癌改良根治术后一期再造乳房的可行性、适应证与方法。方法2006年9月至2010年1月，对59例乳腺癌患者行皮下乳腺切除加腋窝淋巴结清扫术后，应用下腹部腹壁下动脉穿支游离皮瓣（deep inferior epigastfic perforator，DIEP）、背阔肌肌皮瓣（latissimus dorsi myoeutaneous—flap，LDM）、单纯乳房假体植入3种方式一期再造乳房。结果再造手术均取得成功。DIEP再造20例，LDM再造3例，单纯乳房假体植入36例。4例（6．8％，4／59）出现轻微术后并发症。经过3—52个月随访，局部复发率3．4％（2／59），复发转移率5．1％（3／59）。再造乳房形态自然，效果满意，术后外观评价优50例，良7例，一般2例，优良率96．6％。结论从严选择适宜于保留乳房皮肤或乳头乳晕复合体及乳房下皱襞的乳腺癌改良根治术附加一期乳房再造安全可行，合理选择一期乳房再造手术的适应证，有利于再造乳房达到最佳效果，值得应用。

Objective To investigate the feasibility, indications and surgical methods of immediate breast reconstruction after skin-sparing mastectomy. Methods From January 2006 to November 2011, 59 breast cancer patients received skin-sparing modified radical mastectomy plus axillary lymph node dissection and immediate breast reconstruction with deep inferior epigastric perforator flap （DIEP） , latissimus dorsi myoculaneous flap（LDM） or with full-size implants. Results All reconstructions were successful. DIEP breast reconstruction was performed in 20 cases, LDM breast reconstruction in 3 cases, and full-slze implant breast reconstruction in 36 cases. Minor complications were recorded in 4 patients （6.7%）. Aesthetic results were judged as good in 57 patients. Locoregional recurrence was 3.3% by follow-up of 3-52 months. Conclusions Immediate breast reconstruction after skin-sparing modified radical mastectomy in strict selected patients and oncologic criterium is a safe and effective method for 0- IIA stage breast cancer patients, and good results can be obtained in mammary shape, symmetry, mammary skin colour and sensation.