扩大切除结合自体组织皮瓣即刻修复对皮肤广泛受侵乳腺癌的治疗价值

Immediate autologous flap coverage after wide resection in the breast cancer with large cutaneous

目的探讨扩大切除结合自体组织皮瓣即刻修复对皮肤广泛受侵乳腺癌的治疗价值。方法自2005年3月至2013年7月对17例皮肤广泛受侵的乳腺癌,采用了扩大切除即刻自体组织皮瓣修复手术,皮肤受侵面积平均为142.8cm^2。利用腹直肌肌皮瓣修复4例;背阔肌肌皮瓣9例,侧胸壁全层皮瓣4例。结果17例手术均达到病理阴性切缘,无皮瓣缺血、坏死和术后腹壁疝等并发症。中位随访时间33.1个月(1~99个月),随访至2013年8月,术后局部复发2例(11.8%),出现远处转移7例(41.2%),其中3例死亡。术后局部控制率88.2%;术后总生存82.4%;无病生存率58.8%。结论对于皮肤广泛受侵的乳腺癌,采用扩大切除结合自体组织皮瓣修复胸壁软组织缺损,可以获得更多的根治性切除,并可增加长期的局部控制率,有效改善患者的术后生活质量。

Objective To exsplore the value of immediate autologous flap coverage after wide resection in the breast cancer with large cutaneous. Method 17 patients were treated with wide resection and immediate autologous flap cov- erage from March 2005 to July 2013, the mean size of cutaneous tumor was 142.8cm2. 4 patients with transverse rec- tus abdorninis myocutaneous （TRAM） flaps, 9 patients with latissimus dorsi （LD） flaps and 4 patients with pure cu- taneous flaps （PCF）. Result In the all of the cases, Microscopically negative margins were achieved in all of the pa- tients. Complications such as flap necrosis, abdominal hernia weren＇ t found after operations. Median follow-up was 33.1 months （range 1 -99 months）. At the time of follow-up, locoregional relapse was detected in 2 patients,distant metastasis was diagnosed in 7 patients, and death occurred in 3 patients of them. The lasting local control rare was 88.2% ; overall survival rates were 82.4% ; and disease-free survival rates were 58.8%. Condusion The use of im- mediate autologous flap coverage enabled more radical resections with wide excision margins in the breast cancer with large cutaneous, and increased a lasting local control as well as improved the quality of life after surgery.