背阔肌肌皮瓣在乳房重建术中的应用

The application of latissimus dorsi myocutaneous flap in the breast reconstruction

目的探讨背阔肌肌皮瓣在乳房重建术中的应用价值。方法回顾性分析2012年1月至2016年12月期间于笔者所在医院接受背阔肌肌皮瓣乳房重建的36例乳腺肿瘤患者的临床资料,总结术后并发症发生情况及建乳房的美容效果.结果 36例患者中,32例行一期乳房重建,4例行二期乳房重建,均行背阔肌肌皮瓣乳房重建。本组一期重建患者的手术时间为235-490 min(平均325 min),术中出血量为200~260 mL(平均220 mL),住院时间为18~33 d(平均23.6 d).二期重建患者两次手术的合计手术时间为325~550 min(平均355 min),合计术中出血量为200~250 mL(平均220 mL),合计住院时间为27~45 d(平均32.5 d)术后外观评价:优22例,良8例,一般6例,优良率达83.3%(30/36)术后皮瓣全部存活,发生供区血清肿21例,背部皮肤切缘部分坏死1例,乳头和乳晕表皮部分坏死2例一本组所有患者均获访,随访时间为3~60个月,中位随访时间为37个月随访期间,患者无局部复发和远处转移,2例患者接受放射治疗后重建乳房体积萎缩明显。所有患者的患肢功能均未受到明显影响。结论背阔肌肌皮瓣乳房重建是一种操作简便、并发症轻、易处理且效果良好的手术方法。

Objective To explore the value of the application oflatissimus dorsi myocutaneous flap in the breast reconstruction. Methods The clinical data of the 36 patients with breast tumor who had undergone breast reconstruction with latissimus dorsi myocutaneous flap from January 2012 to December 2016 were collected retrospectively. The postoperative complications and cosmetic results were analyzed. Results Thirty-six patients with breast tumor who underwent breast reconstruction with latissmus dorsi myocutaneous flap, including 32 patients with immediate breast reconstruction and 4 patients with delayed breast reconstruction respectively. The operative time of the patients who undertwent immediate breast reconstruction was 235-490 min （mean of 325 min）, the intraoperative blood loss was 200-260 mL （mean of 220 mL）, and the hospitalization time was 18-33 d （mean of 23.6 d）. The total operative time of patients who underwent delayed breast reconstruction was 325-550 min （mean of 355 rnin）, the total intraoperative blood loss was 200-250 mL （mean of 220 mL）, and the total hospitalization time was 27-45 d （mean of 32.5 d）. The cosmetic results was excellent in 22 patients, good in 8 patients, fair in 6 patients, respectively, and fine rate was 83.3% （30/36）. There was no flap loss, but donor site seroma occurred in 21 patients, partial necrosis of the surgical margin of back skin occurred in 1 patient, partial necrosis of the nipple and areola skin occurred in 2 patients. All the patients were followed-up for 3-60 months, and the mean follow-up time was 37 months. During the follow-up period, no patient occurred metastasis or recurrence. After undergoing radiotherapy, reconstructive breast volume of 2 patients significantly contracted. None of the patients had significant limb function. Conclusion The breast reconstruction with the latissimus dorsi myocutaneous flap is a simple, easy, and effective surgical procedure.