扩张皮瓣修复局部晚期乳腺癌术后软组织缺损的围手术期护理

Nursing of patients undergoing soft tissue defect repair using expanded flap after breast cancer surgery

目的总结应用邻近扩张皮瓣修复局部晚期乳腺癌术后胸壁软组织缺损的围手术期护理方法。方法对13例局部晚期乳腺癌（locally advanced breast cancer,LABC）患者接受新辅助化疗前使用水囊扩张器扩张皮瓣,4个疗程新辅助化疗后行乳腺癌改良根治术并一期修复手术后胸壁软组织缺损。治疗过程做好水囊扩张期间注射壶、腹壁扩张皮瓣和注水的护理工作,皮瓣修复后做好皮瓣生长护理工作。结果患者均顺利完成水囊扩张器植入术,并完整修复胸壁软组织缺损,未出现皮瓣坏死,随访6-24个月未发现肿瘤转移。结论扩张皮瓣修复LABC手术后胸壁软组织缺损围手术期间,扩张器植入后皮瓣扩张过程皮瓣护理及手术修复后创面护理是手术成功的重要因素。

Objective To summarize the experience in nursing the patients undergoing soft tissue defect repair using expanded flap after surgery of locally advanced breast cancer（LABC）. Methods Thirteen LABC patients received neoadjuvant chemotherapy.Water balloon dilator was used to expand flap before the chemotherapy and expanded flap was used to repair the soft tissue defect after modified radical mastectomy. Skin preparation and psychological counseling were well prepared before operation. During therapy, more attention was paid to injection pot, abdominal wall flap and water injection and the nursing of the expanded flaps after repair. Results The water balloon dilator implantation for all patients was successful and soft tissues of chest wall defect were completely repaired. There wasn＇t flap necrosis or implantation metastasis in 0.5 to 2 years follow- up. Conclusion Expand flap can repair defect of chest wall after modified radical mastectomy. The nursing measures of perioperative nursing including implantation of expander, observation of the expanded flap variations during expanding of water sac and nursing of expanded flaps are important for the success of repair.