乳腺癌全乳切除术后扩大背阔肌肌皮瓣乳房重建:附150例报告

Extended latissimus dorsi flap for breast reconstruction after total mastectomy for breast cancer: a report of 150 cases

目的：探讨改良根治术全乳切除联合一期扩大背阔肌肌皮瓣乳房再造术治疗乳腺癌的临床疗效。方法：回顾性分析2008年3月—2013年3月行乳腺全切除的150例乳腺癌患者的临床资料,其中传统的改良根治术28例,保留皮肤的全乳切除术47例,保留乳头乳晕的全乳切除术75例,均同期行扩大背阔肌肌皮瓣乳房再造术。结果：手术成功149例,失败1例。再造乳房外观评价＂优良＂率达91.27%（136/149）。术后发生乳头部分坏死4例,发生胸部皮肤挫伤、表皮脱落3例,未经特殊处理,自行愈合;出现背部血肿8例,其中6例经穿刺抽液愈合,1例经切除纤维囊愈合,1例经刮除窦道假膜愈合;切缘皮肤局部坏死2例,背部供区部分坏死2例,经二次手术愈合;移植物缺血坏死1例,给予切除处理。随访8~73个月（失访18例,失访前均无瘤生存）,骨转移2例,肺转移1例,锁骨上淋巴结转移1例,无局部复发患者。结论：乳腺癌改良根治术乳腺全切除联合I期扩大背阔肌肌皮瓣乳房再造术,安全有效,尤其适用于中小体积乳房的患者。

Objective：To assess the clinical efficacy of the modified radical mastectomy with first-stage breast reconstruction using extended latissimus dorsi flap in treatment of breast cancer.Methods：The clinical data of 150 patients with breast cancer undergoing total mastectomy from March 2008 to March 2013 were retrospectively analyzed.Of the patients,the traditional modified radical mastectomy was performed in 28 cases,skin sparing total mastectomy was performed in 47 cases,and nipple sparing total mastectomy was performed in 75 cases,and all of the cases received synchronous breast reconstruction using extended latissimus dorsi flap.Results：The operation was performed successfully in 149 patients and failed in one patient.The excellent/good rate of the appearance evaluation of the reconstructed breast reached 91.27%（136/149）.After surgery,partial nipple necrosis occurred in 4 patients,and chest skin contusion with exfoliation occurred in 3 patients,all of which healed spontaneously without special treatment;dorsal hematoma occurred in 8 patients,of whom 6cases resolved by puncture and aspiration,one case was cured by removal of the fibrous capsule,and one case was cured after resection of the sinus tract and false membrane;local skin necrosis at the margin of wound occurred in 2 patients,and partial necrosis in the donor region of the flap occurred in 2 patients,which were resolved by a second surgery;ischemic necrosis of the graft occurred in one case,which was treated by surgical resection.Followed-up was performed for 8 to 73 months（18 patients were lost to follow-up,all of whom had diseasefree survival before lost to follow-up）,during which time,2 patients developed bone metastases,one case each developed pulmonary metastases and supraclavicular lymph node metastases,and no local recurrence occurred in any of the patients.Conclusion：Modified radical mastectomy with first-stage breast reconstruction using extended latissimus dorsi flap in treatment of breast cancer is safe and effective,and is especially suitable for the patients with small or medium breast size.