10例保留皮肤的乳腺癌改良根治术后即时TRAM皮瓣乳房再造体会

Treatment Experience about The Skin-Sparing Mastectomy and Immediate Breast Reconstruction of 10 Cases

目的总结保留皮肤乳腺癌改良根治术后即时乳房再造方法的治疗体会。方法笔者所在医院2008年5月至2011年12月期间对10例早期乳腺癌患者行保留大部分皮肤的改良根治术,同时应用下腹部腹直肌带蒂肌皮瓣(TRAM)行即时乳房再造,就该10例患者的临床资料进行回顾性分析。结果 10例患者中1例TRAM皮瓣部分坏死,1例乳头部分坏死,1例再造乳房乳尾部脂肪部分坏死伴腋下伤口感染;无腹壁切口疝发生,无全部TRAM皮瓣坏死病例。术后患者对再造乳房形态评价非常满意5例,比较满意4例,不满意1例。结论保留皮肤的乳腺癌改良根治术后即时TRAM皮瓣乳房再造方法的切口小,再造乳房形态好,是一种安全有效的治疗早期乳腺癌患者的方法。

Objective To introduce the treatment experiences about the skin-sparing mastectomy and immediate breast reconstruction. Methods The skin-sparing mastectomy and immediate breast reconstruction by using transverse rectus abdominis myocutaneous （TRAM） flat were performed in 10 patients with early-stage breast cancer from May 2008 to December 2011 in our hospital. The patients＇ data were retrospectively analyzed. Results There were postop- erative complications after skin-sparing mastectomy and immediate breast reconstruction, including TRAM flat necrosis in 1 case, papillary necrosis in 1 case and fat necrosis in the reconstructed breast with oxter wound infection in 1 case. There was no incision hernia of abdominal wall or necrosis of all TRAM flat in any case. The patients＇ satisfaction that evaluation for the breast shapes of reconstructed breasts was very satisfaction in 5 cases, part satisfaction in 4 cases, and dissatisfaction in 1 case, respectively. Conclusions Because of the minimal access approach and good breast shape, the skin-sparing mastectomy and immediate TRAM fiat breast reconstruction is a safe and effective way for treating early- stage breast cancer.