乳腺筋膜瓣在保乳成形手术中的应用价值

Application of adipofascial flaps in mammoplasty

目的：探讨乳腺筋膜瓣在保乳成形术中修复缺损的手术方法及治疗效果。方法于保乳手术前、后分别测量35例体型分类为中间型的女性乳腺癌患者乳头到胸骨上窝距离和乳头到正中线距离并记录，术中整体切除乳腺病灶及周围组织1∽2 cm，测量切除组织的质量，同时应用宽基底脂肪筋膜组织瓣翻转填充缺损的Ⅰ期乳房内行成形术，随访观察缺损组织质量与乳腺筋膜瓣填充效果的关系。结果35例患者术中切除组织质量为（69.63±11.74）g；治疗前、后乳头到胸骨上窝距离及乳头到正中线距离的差异均无统计学意义（ P＞0.05）；术后切口均Ⅰ期愈合，无皮瓣坏死，无脂肪坏死。35例患者中4例术后出现明显凹陷，其余患者总体乳房美容效果满意，达优率为88.6％（31／35）。随访时间为4∽30个月（中位随访时间为19个月），全组患者均无远处转移，无局部复发。结论中间型女性乳房缺损组织质量在（69.63±11.74）g内，可通过乳腺筋膜瓣移位填充缺损的方法实施乳腺内成形。手术简单，疗效满意，为乳腺癌保乳手术的选择提供了参考。

Objective To investigate the application of adipofascial flaps for the repair mammary defects in breast.conserving surgery. Methods The distance from the nipple to the stemum and nipple to the midline of 35 middle type women patients were meas.ured before and after mammoplasty. Total excision of breast lumps and surrounding tissue were performed, and the tissue removed from patients was weighed. Breast reconstruction was accomplished synchronously with the application of a wide.based mammary adipofascial flap in stageⅠbreast reconstruction. The relationship between the quantity of tissue defects and the filling effect of fascial flap in mam.moplasty were analyzed as follow.up. Results The median weight of the tissue removed from 35 patients was （69.63±11.74） g. There were no statistically significant differences in the distance from nipple to the sternum or nipple to the midline before and after treatment （P〉0.05）. Postoperative incisions showed proper healing, with no skin flap necrosis or fat necrosis. 3 patients who underwent radio.therapy for fat liquefaction necrosis, showed effusion, pumping well. Breast malignant lesions were excised completely with negative margins on pathological examination, and a basal adipofascial flap was generated,showing a significant depression in 4 patients. The rate of mammoplasty was 88.6%（31/35） according to Joint Center of Radiotherapy（JCRT）. The follow.up period of 4.30 months in the 35 patients（ average follow.up was 19 months） . No distant metastases or local recurrence was observed. Conclusion Patients clas.sified as middle type had an average weight of tissue removed of （69.63±11.74） g, and the defect were corrected using a mammary gland fascial flap. The operation is simple and the curative effect is satisfactory, providing a reference for breast.conserving surgery.