乳腺癌改良根治术后Ⅰ期假体植入临床分析

Experience of immediate breast reconstruction with silicagel

目的 探讨乳腺癌改良根治术后Ⅰ期假体植入乳房重建临床相关问题.方法 2007年6月至2011年12月,对陕西省肿瘤医院乳腺中心收治的30例乳腺癌行保留皮肤的乳腺癌改良根治术,同期于胸大、小肌间植入硅胶假体重建乳房,其中15例保留乳头乳晕复合体,术后进行常规治疗.结果 30例客观评价效果优良达90.0％,主观评价效果优良93.3％.2例出现皮瓣下积液,予以穿刺抽吸;1例出现轻度包膜挛缩;1例出现乳头乳晕区皮瓣坏死,换药后愈合;1例出现假体移位;1例因对侧乳房下垂致外观不对称.随访12 - 54个月,1例发生肝转移、骨转移,余29例无局部复发或远处转移.结论 乳腺癌改良根治术后Ⅰ期假体植入乳房重建,美容效果满意,不增加局部复发风险,改进手术细节可降低并发症发生,安全可行.

Objective To investigate the clinical correlated problems of immediate breast reconstruction with silicagel prosthesis after modified radical mastectomy.Methods From Jun.2007 to Dec.2011,30 patients were treated with skin sparing modified mastectomy and immediate reconstruction by placing silicone implants into submuscle.15 cases were reserved the nipple-areola complexes.All patients were treated routinely after operation.Results Objective evaluation after operation showed that the excellent rate reached to 90.0％,and subjective evaluation showed that the excellent rate reached to 93.3％.Two cases suffered under-flap hydrops,one case suffered capsular contraction,one case suffered flap ischemia and superficial necrosis of nipple-areola complex,one case suffered gel metastasis,and one cases suffered obvious asymmetry.All the cases were followed up for 12 to 54 months,among whom one case had hepatic and bone metastasis,and the others had no recurrence or metastasis.Conclusions Immediate breast reconstruction with silicagel prosthesis after modified radical mastectomy was proven to be an effective and safe method,with no increase of local recurrence.The modification of operation may avoid the risk of complications.