保留乳房外形的乳腺手术的临床应用研究

Clinical research of breast shape reserving surgery

目的:探讨利用背阔肌皮瓣、腹直肌肌皮瓣(r ect us abdomi ni s myocut aneous f l ap,TRAM),假体或者联合使用开展保留乳房外形的乳腺手术的手术适应证,方式选择,手术并发症。方法:2007年5月至2009年2月行背阔肌皮瓣,腹直肌皮瓣,假体,以及联合使用的保留乳房外形的乳腺手术21例。观察指标包括手术方式的选择,手术时间,术后并发症以及美学效果。结果:背阔肌皮瓣改良保乳术12例,平均时间289mi n;腹直肌皮瓣改良保乳术4例,平均时间393 mi n。利用腹直肌和背阔肌皮瓣修复乳癌术后胸壁巨大缺损1例。Paget病利用腹直肌和背阔肌皮瓣行乳房再造术1例。乳癌术后行游离腹直肌皮瓣乳房再造术1例。保留皮肤乳头乳晕全切术后背阔肌乳房再造术1例。乳房全切后乳房即刻再造术1例。再造乳房有2例失败,其余乳房存活良好,手术并发症少。结论:利用自体组织或者假体行改良保乳术或者乳房再造术,操作时间不长,术后并发症少,美学效果好,基本不影响患者的后期治疗。

Objective To investigate the surgical indication,method choice and complications of the surgery to preserv- ing the breast shape using the latissimus-dorsi flap （LDF）,rectus abdominis myocutaneous flap （TRAM）,prosthesis or combined method. Methods From May,2007 to February,2009,21 cases of breast shape reserving surgery using the LDF,TRAM flap,prosthesis or combined method were done. Outcome measures included choice of techniques,operation time,postoperative complications and aesthetic effects. Results 12 cases of breast shape reserving surgery using the LDF were done and the average operation time was 289 minutes. Four cases of breast shape reserving surgery using the TRAM flap were done and the average operation time was 393 minites.One case of reparing the large chest wall defect postmastectomy using the LDF and TRAM flap was done. One case of Paget disease breast reconstruction using the LDF and TRAM flap was done. One case of breast reconstruction post-mastectomy using the free TRAM flap was done. One case of breast reconstruction using the LDF after the skinsparing resection of the whole nipple and areola was done. One case of immediate breast reconstruction after mastectomy was done.Two cases failed,while other ones were successful with few complications. Conclusion Breasts＇shape reserving surgeries （Modified breastconserving surgery or Breast reconstruction surgery） using autologous tissues or prosthesis is feasible,with short operation time,few complications, nice asthetic effects and little influence for postoperative treatment.