背阔肌脂肪瓣一期乳房再造术的临床研究

Study on Real time Breast Reconstruction Using Latissimus Dorsi Flap After Modified Radical Mastectomy Reserving Nipple and Areola Mamma

目的 :研究一种既达到肿瘤根治性切除目的 ,又保留乳房美观外形的简便省时、完全可靠的手术方法。方法 :选临床Ⅰ、Ⅱ期乳腺癌患者 ,经腋后线切口行肿瘤根治切除术 ,切除肿瘤表面皮肤 ,保留乳头乳晕 ,取部分背阔肌脂肪瓣行Ⅰ期乳房再造。结果 :4 6例接受乳房再造患者成功 4 5例 ,再造乳房美观效果为优者 34例 (75.6 % ) ,良 7例 (15.5% ) ,差 4例 (8.9% ) ;随访满 1,2 ,3年者分别为 9,11和 16例。除 1例腋淋巴结转移 17枚患者术后 38个月出现骨转移及锁骨下复发外 ,其余均无瘤生存。结论 :使用背阔肌瓣重建乳房 ,组织量适中 ,损伤小 ,外形美观 ,适合应用于中国女性。

Objective:To avoid the contour destruction caused by modified radical mastectomy and to improve the patients'psychological condition and the quality of life,we designed a new breast construction operation.Methods:Forty six breast cancer patients were treated with the modified radical operation reserving nipple and areola mammae and real time breast reconstruction by latissimus dorsi flap.Results:We followed up 16 cases for more than 3 years,11 cases for more than 2 years and 9 cases for more than 1 years,Except the patient with 17 metastatic lymph nodes in axill who had bone metastasis and recurrence in partes infraclaviculararea 38 months after peration,all patients survive without tumor.All upper limbs are with good function.In 45 cases with successful breast reconstruction,there are 34 excellent cases (75.6%),7 good cases (15.5%) and 4 average cases (8.9%) according to the aesthetic viewpoint.Conclusions:This operation has the following advantages:simple and convenient operating,low blood loss,no function disorder,reconstructed breasts with good contour and feeling,excellent follow up result.Furthermore,this method is very safe because we reconstruct the breast after radical operation,and the patient can accept other treatments.