不同手术方式在乳腺恶性肿瘤术后胸壁巨大缺损修补中的应用价值

The value of different surgical methods in the repair of huge chest wall defect after breast malignant tumor operation

目的探讨不同手术方式在修补乳腺恶性肿瘤术后胸壁巨大缺损中的应用价值。方法回顾性分析安徽医科大学第一附属医院乳腺外科2013年4月至2017年11月共22例乳腺恶性肿瘤手术后胸壁缺损的患者．运用不同的手术方法均行I期胸壁缺损修复。其中9例行背阔肌肌皮瓣转移修补术，4例行对侧乳腺内乳穿支皮瓣转移修补术，余行植皮术。结果22例修补手术均取得成功。2例植皮患者术后植皮区轻度水肿，经积极换药后痊愈。所有患者无积液，感染和坏死等并发症发生。术后随访6个月～2年，除1例出现肝转移外，其余患者均无出现复发和远处转移。结论运用不同手术方法修补乳腺恶性肿瘤术后胸壁的巨大缺损，操作简单，安全有效，提高了乳腺癌患者的生活质量。应根据患者胸壁缺损的具体情况，选择最适合患者的修补方式。

Objective To evaluate the value of different surgical methods in the repair of huge chest wall defect after breast malignant tumor operation. Methods The clinical data of 22 patients with chest wall defect after chest operation were retrospectively analyzed. All patients received one-stage repair for the chest wall defect with different surgical methods. Of the patients, 9 cases got repair with latissimus dorsi myocutaneous flap, 4 cases received repairment with internal mammary perforator flap of contralateral breast, and the others received dermatoplasty. Results All the 22 cases were successfully repaired. Two cases of dermatoplasty got mild edema who was healed after acitive dressing change. No one got effusion, infection or necrosis. No recurrence or distant metastasis happened except one case of liver metastasis in the follow-up of 6 to 24 months. Conclusions Appli- cation of different surgical methods in repair for the chest wall defect can improve patients＇ life quality. It is easy, safe and effective. We should choose the most suitable surgical method according to individual situation.