乳腺癌改良根治同时以背阔肌瓣乳房形成术32例

Real-time Breast Reconstruction Using Latissmus Dorsi Flap after Modified Radical Operation of Breast Cancer Reserving Nipple and Areola

目的:为消除根治手术对乳腺癌患者所致的形体破坏,改善患者的心理、生理状况及生活质量,探讨一种既达到肿瘤根治性切除,又保留乳房美观外形的简便省时、安全可靠的手术术式。方法:选肿瘤≤4cm,距乳头≥3cm,未侵及皮肤及胸肌的乳腺癌患者,经腋后线纵形切口并切除肿瘤表面皮肤,行保留乳头乳晕的改良根治术,术中乳头后乳腺组织断面快速病检为阴性,即刻取部分背阔肌瓣行乳房再造。结果:手术32例,1例因背阔肌瓣坏死失败,31例乳房再造成功,其中优22例(71.0%),良5例(16.1%),差4例(12.9%);仅1例再造失败(背阔肌瓣坏死予以切除)。随访3年以上9例,随访2～3年11例,2年以下12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:本手术切口隐蔽,且保留了乳头乳晕,再造乳房外形美观、逼真,手感良好。手术简便省时,安全可靠,损伤较小。

Objective:To avoid the contour destruction caused by breast cancer radical op-eration,to improve the patients psychological condition and the quality of life,we designed a new method of breast reconstruction operation.Methods:A modified radical operation reserving nip-ple and areola was indicated in patients with the tumor size smaller than4cm and3cm far from nipple and without involvement of skin and pectoris muscle.A longitudinal incision along the posterior axillary line was made;and if the quick-frozen section of the mammary gland tissue be-neath the nipple was negative,the tumor with the covering skin was resected and the nipple and areola were reserved.A part of latissmus muscle flap was shifted to reconstruct the breast.Results:In31cases of successful breast reconstruction,with excellent 22(71.0%)cases,good5(15.5%)cases,fair4(8.9%)cases,but only one case failed.Nine cases were followed up for more than3years,11cases for2-3years and12cases less than2years.Except one patient with17axillary lymph nodes metastases had subclavian recurrence and bone metastasis after op-eration all the others survived without tumor recurrence.Conclusion:This modified radical op-eration has the advantages of simple,safe,mild trauma and especially with good cosmetic out-come.