侧胸壁血管带蒂复合组织瓣在乳腺癌保乳术乳房重塑中的应用

Application of lateral thoracic wall vascular pedicled composite tissue flap in breast conserving surgery and remodeling breast shape

目的应用侧胸壁血管带蒂复合组织瓣重塑乳腺癌保乳术乳房外形，并观察其术后效果。方法兰州市妇幼保健院乳腺外科2016年4月至2017年12月对10例乳腺癌患者接受该手术方式，利用侧胸壁动静脉血管作为血管蒂转移该组血管支配的远端复合组织瓣来修复填充乳腺癌保乳手术后所形成的乳房大体积缺损残腔，以期达到乳腺癌保乳手术后乳房良好的外形。结果10例手术均顺利完成，术中出血约20～30ml，手术时间2～3h，无输血病例，平均住院天数11．5（10～15）d，手术后切口无感染，愈合良好。10例均随访，平均随访时间11（2～20）个月，无患肢水肿、失对称性及局部复发等并发症，乳房获得良好的美容效果。结论该手术方式针对肿物较大但保乳意愿强烈的患者而言是有效、安全、经济的手术方式。

Objective To introduce a breast conserving surgery for reconstruction of breast shape and to demonstrate the postoperative effect. Methods Ten patients were treated with this method from Apr. 2016 to Dec. 2017, and the lateral thoracic wall arteriovenous vessels were used as vascular pedicle to transfer the distal compound tissue flap of the blood vessel to repair the breast defect remnant cavity which was formed after the breast conserving surgery, and a good shape was obtained. Results All the 10 cases were successfully completed. The intraoperative bleeding was 20 to 30 ml. The operative time was 2 to 3 hours. No blood transfusion was needed. The average hospital stay was 11.5 days, ranging from 10 to 15 days. No infection happened to the incision. All the 10 patients were followed up from 2 to 20 months, with 11 months as the average. No limb edema, asymmetry or local recurrence happened. Conclusion The operation method is effective, safe and economical for patients with large swelling but strong desire to conserve breast.