乳腺癌术后修复重建的临床经验

Clinical experience of breast reconstruction after breast cancer operation

目的探讨国人乳腺癌术后修复重建的经验。方法回顾性分析2009年11月至2011年1月海南省农垦总医院收治的15例乳腺癌术后自体组织修复重建患者的临床资料。结果 15例手术患者中,即刻修复5例(4例为即刻修复临床Ⅳ期乳癌术后胸壁创面),延期修复10例。单纯应用背阔肌肌皮瓣带蒂转移3例(2例为即刻修复保乳术后局部缺损),背阔肌肌皮瓣带蒂转移加乳房假体3例,乳腺瓣修复保乳术后局部缺损1例,内窥镜辅助背阔肌肌瓣带蒂转移修复保乳术后乳腺局部缺损1例,组织扩张术行局部皮瓣转移2例。随访2～15个月,皮瓣全部成活,创面愈合良好,形态满意。结论自体组织修复保乳术后的局部缺损对于乳房普遍较小的中国患者实用方便,设计灵活,可同时修复腋窝缺损,不影响放疗和化疗的及时进行,具有良好的应用前景。

Objective To introduce the application experience of immediate and delay, total and partial breast reconstruction with latissimus dorsimyocutanuous flap after surgical of breast cancer. Methods Clinical data of 15 cases of breast reconstruction with latissimus dorsimyocntanuous flap from Nov. 2009 to Jan. 2011 were analyzed retrospectively. Results Five patients were received immediate breast reconstruction （4 cases were used for surface covering post mastectomy for clinical 1V stage）, 10 patients were re- ceived delayed breast reconstruction. Three patients were received transposition and repair of latissimus dorsimyocutaneous flap with pediele only（2 cases received repair of partial deformity after breast conversation therapy）. Three patients of breast reconstruction were used latissimus dorsimyocutaneous flap transposition with pedicle plus breast implant. Partial deformity after breast conversation therapy were repaired using skin flap of healthy breast （ 1 patient）. One patient was received transposition and repair of latissimus dorsimyocu- taneous flap under the helping of endoscope. Two cases were used transposition of local flap with tissue expander. The entire flap sur- vived well with satisfied results. Conclusion The autografting in repairing the partial tissue deformity after breast conversation therapy has become convenient and agility for Chinese patients with smaller breast generally. Meanwhile, breast autologous reconstruction can repair the deformity of axilluary and not affect the treatment of radiotherapy and chemotherapy after breast conversation. Thus, it will have a good prospect.