乳腺切除术后全乳再造37例临床研究

Clinical Investigation to Breast Reconstruction with Pedicled Flap after Mastectomy in 37 Cases

目的探讨带血管蒂转移皮瓣在乳腺癌术后乳房再造中的安全性和整形效果。方法 2004年3月—2010年6月,对37例乳腺肿瘤患者,行乳房切除术后带蒂背阔肌或TRAM皮瓣乳房再造。其中Ⅰ期再造34例,Ⅱ期再造3例;对其中15例TRAM皮瓣再造的供区下腹部应用涤纶补片加强腹壁。结果 1例TRAM皮瓣小部分坏死,6例Ⅰ期再造术后乳房本体皮肤坏死。3例背阔肌皮瓣再造发生背部皮下血清肿;3例TRAM皮瓣下腹中段脂肪液化,无腹壁膨隆或腹壁疝发生。随访2月—72月,1例肿瘤局部复发,1例肝转移。乳房外观评价,总体可接受度94.59%。结论背阔肌或TRAM带血管蒂转移皮瓣再造是乳房切除术后行全乳再造的有效和安全的方法,应用涤纶补片加强腹壁可以有效预防腹壁软弱和腹壁疝形成。

Objective To investigate the efficacy and safety for breast reconstruction with pedicled flap after mastectomy.Methods From March 2004 to June 2010,37 cases of breast reconstruction were carried out with pedicled flap,TRAM or Latissimus dorsi,of which 34 were immediate and 3 were delayed.Synthetic mesh was applied to reinforce the abdominal wall after pedicled TRAM flap in 15 patients.Results Partial flap necrosis was observed in 1 patient with TRAM;skin necrosis occurred in 6 patients with immediate reconstruction;subcutenous seroma collection at dorner site was found in 3 patients with Latissimus dorsi;fat necrosis occurred at the abdominal incision for 3 patients with TRAM;no abdominal bulge or hernia was observed.With the follow-up from 2 months to 72 months,1 local recurrence and 1 distant recurrence were observed.The overall satisfaction rate was 94.59%.Conclusion Breast reconstruction with pedicled flap,TRAM or Latissimus dorsi,was both effective and safe,furthermore synthetic mesh applied was able to strengthen abdominal wall and avoid abdominal hernia.