乳腺外科整复术在乳腺癌保乳根治术中的应用

Oncoplastic technique in breast conservation surgery

目的：探讨乳腺外科整复术在乳腺癌保乳手术中的临床应用价值。方法：分析2010年1月至2011年6月期间应用乳腺外科整复术行保乳手术病例87例,术中根据肿瘤的大小和位置设计乳房切口。行局部扩大切除术,切缘距瘤缘的距离为1~2cm。乳房缺损部位的修复采用自身乳腺组织瓣修复法和乳腺以外的组织瓣修复法。术后1年对乳房美容效果进行客观评价和主观满意度调查。结果：年龄：29~66岁,中位年龄47岁。肿瘤大小：1~5cm,平均2.4cm。术式选择：蝙蝠翼整形11例,环乳晕整形8例,下蒂倒T整形18例,上蒂倒T整形12例,内侧整形8例,外侧整形13例,J整形2例,侧胸部带蒂脂肪筋膜组织瓣修复法9例,腹直肌鞘脂肪筋膜组织瓣修复法6例。切缘阳性率为8.0%。并发症发生率为1.6%。乳房美容效果：客观满意率为86.2%,主观满意率为88.5%。全部病例随访38~60个月,中位随访54个月,局部复发率为5.7%,5年总生存率为94.3%,5年无远处转移生存率为90.8%。结论：乳腺外科整复术术后美观效果好,患者满意度较高。

Objective：To evaluate the clinical value of oncoplastic technique in breast conservation surgery. Meth- ods：Clinical data of 87 breast cancer patients who received oncoplastic surgery from January 2010 to June 2011 were retrospectively analyzed. The breast incision was disigned based on the diameter and the location of tumor. Many methods were used to repair breast defects, one was volume displacement procedure, the other was volume replacement procedure. Objective evaluation and subjective satisfaction survey were assessed 1 year after operation. Results：The median age of the patients was 47 years（range 29 to 66 years）. The average diameter of tumors was 2.4 era（range 1.0 to 5.0era）. Choice of operation method： 11 were batwing mammaplasty,8 were peri- areolar mammaplasty, 18 were inferior pedicle inverted- T mammaplasty, 12 were upper pedicle inverted -T mammaplasty ,8 were medial mamma- plasty,13 were lateral mammaplasty,2 were J- mammaplasty,9 were lateral thoracoaxillar fat tissue flap and 6 were inframammary adipofascial flap. The rate of positive surgical margin was 8.0%. The rate of complication was 4.6%. Cosmetic outcome：The objective satisfaction rate was 86.2% ,subjective satisfaction rate was 88.5%. The mean fol- low - up period was 54 months （range 38 to 60 months）. The local recurrence rate was 5.7 %. 5 - year overall survival rate was 94.3%. Conclusion：Breast oncoplastic techniques can get a satisfactory cosmetic appearance.