应用背阔肌与胸大肌联合肌瓣及假体置入即刻乳房再造

Immediate implanting breast reconstruction with combined muscle flap of pedicled latissimus dorsi and pectoralis major muscle

目的探讨经乳房外侧弧形切口皮下乳腺切除术后，带蒂转移背阔肌肌瓣，与胸大肌肌瓣形成联合肌瓣覆盖乳房假体，进行即刻乳房再造术的治疗效果。方法选择临床分期为Ⅰ期或Ⅱ期．肿瘤未侵及皮肤和胸肌的乳腺癌患者共30例，经乳房外侧弧形切口皮下切除乳腺腺体并清扫腋窝淋巴结，利用同一切口，切取背阔肌肌瓣带蒂转移，分离胸大肌下间隙，切断胸大肌下缘与胸壁附着处直至胸骨边缘，将转移的背阔肌肌瓣与胸大肌断缘缝合，组成联合肌瓣，形成宽大的包裹假体的腔隙．置入假体。结果30例再造乳房外形及手感良好，其中优22例（73．3％），良8例（26．7％）。术后所有患者均随访半年以上，均无瘤生存。结论再造乳房形态美观，能够置入较大的假体，不增加背部的切口，适合于无淋巴结转移、对侧乳房无明显下垂的早期青年乳腺癌患者的即刻乳房再造。

Objective To explore immediate implanting breast reconstruction after subcutaneous mastectomy by through breast lateral curved incision with combined muscle flap of pedicled latissimus dorsi and pectoralis major muscle covering the breast prosthesis. Methods 30 patients were selected in clinical stage Ⅰ or Ⅱ , and without involvement of skin and pectoral muscle. After subcutane- ous mastectomy through breast lateral curved incision, by the same incision the latissimus dorsi muscle flap was removed and transferred, and the submuscular interspace was dissected, and the inferior border of the pectoralis major muscle was cut off. The pedicled latissimus dorsi and pectoralis major mus- cle flap were sutured and the combined muscle flap was formed to cover the breast prothesis. Results The shape and feeling were satisfactory in 30 reconstructive breasts, and 22 cases were excellent （73.3 %）, and 8 cases were good （26.7 %）. All the patients survived without tumor recurrence after following-up more than half a year. Conclusions The method has advantages of good cosmetic breast shape, without appendant incision, and larger breast prosthesis could be insertted. It is a good method of immediate breast reconstruction for the young women with early stage breast cancer without axillary lymph node metastasis.