转移背阔肌肌皮瓣修复局部晚期乳腺癌术后胸壁缺损

The Transferring Latissimus Dorsi Muscular Flap Repair the Chest Wall Defects after Radical Mastectomy for Locally Advanced Breast Cancer

目的总结转移背阔肌肌皮瓣在修复局部晚期乳腺癌术后胸壁缺损中的优势。方法回顾性分析2010年8月~2016年8月我院收治的32例局部晚期乳腺癌患者的临床资料。根据胸壁缺损修复方式分为两组:27例采用转移背阔肌肌皮瓣修复根治性切除术后胸壁缺损(转移背阔肌肌皮瓣组);5例采用中厚皮片植皮修复胸壁缺损(中厚皮片植皮组)。比较两组患者皮瓣或植皮坏死情况、术后并发症、术后放疗实施等情况。结果转移背阔肌肌皮瓣组27例中无肌皮瓣坏死,术后血清肿6例,腋窝积液5例,伤口感染1例;术后2月均予以放疗。中厚皮片植皮组5例中术后植皮坏死3例,其中2例患者再次植皮术后恢复,1例以邻近皮瓣转移修复;伤口感染1例;完成辅助化疗后术后2月3例患者行放疗。两组患者转移皮瓣或植皮坏死率、术后2月开始放疗率比较,差异均有统计学意义(P<0.05),而组间其他并发症比较,差异无统计学意义(P>0.05)。结论转移背阔肌肌皮瓣修复局部晚期乳腺癌术后胸壁缺损安全、成功率高,利于术后放射治疗的顺利实施。

Objective To summarize the merit of the transferring musculocutaneous flap of latissimus dorsi muscle in repairing the chest wall defects after radical mastectomy for locally advanced breast cancer （LABC）.Methods The clinical data of 32 LABC patients who underwent radical or modified radical mastectomy in our hospital from August 2010 to August 2016 were reviewed retrospectively.According to repairing surgery of chest wall defects,all cases were divided into two groups：27 cases were repaired with the transferring musculocutaneous flap of latissimus dorsi muscle as group A,and 5 cases were repaired with free intermediate split thickness skin graft as group B.The necrosis of musculocutaneous flap or skin graft,postoperative complication and adjuvant radiotherapy performance were compared between two groups.Results All musculocutaneous flaps were survival without necrosis,but seroma was found in 6 cases,axillary hydrops in 5 cases and wound infection in l case in the group A.All 27 cases were performed adjunct radiotherapy 2 months after the surgery.The skin graft necrosis was found in 3 cases of group B,and cured by skin re-grafting in 2 cases and adjacent flap transfer repair in 1 case.There was wound infection in one case.3 cases received radiotherapy 2 months after the surgery.There was statistical difference in necrosis rate of transferring musculocutaneous flaps/skin flaps and executing rate of radiotherapy between two groups （P ＜0.05）,while no statistical difference in other complications between two groups.Conclusion The grafting of transferring musculocutaneous flap of latissimus dorsi muscle is a safe,simple and convenient method for repairing the chest wall defects after radical mastectomy for LABC,and it can improve the patient＆#39;s recovery fast and ensuring radiotherapy executing successfully.