新月形切口联合腹部推进皮瓣在中-小乳房下极乳腺癌保乳术中的应用效果

Application effect of crescent incision combined with abdominal advancement flap in breast conserving surgery for moderate-to small-sized breast cancer

目的探讨新月形切口联合腹部推进皮瓣在中-小乳房下极乳腺癌保乳术中的应用效果。方法选取2014年12月~2017年5月我院收治的肿物位于下极的中-小乳房乳腺癌患者38例,根据保乳术中所应用乳房切口的不同分为新月形切口保乳组(观察组18例)和倒T形切口保乳组(对照组20例)。比较两组患者的乳房体积、肿物直径、切除组织量、切除组织量占比,术后并发症及美容效果,采用SPSS 19.0软件对数据进行统计分析。结果观察组的乳房体积小于对照组,切除组织量占比高于对照组,差异均有统计学意义(P<0.05)。中位随访时间为22个月(6~30个月),观察组1例早期出现局部皮瓣缺血但未坏死,对照组2例出现局部皮瓣缺血坏死,所有患者均未出现局部复发和远处转移。两组患者术后美容效果比较,差异无统计学意义(P>0.05)。结论在肿物位于乳房下极的乳腺癌保乳术中,合理运用新月形切口联合腹部推进皮瓣的肿瘤整形方法,可以使患者获得良好的美容效果,简单易行,值得推广。

Objective To evaluate the application effect of crescent incision combined with abdominal advancement flap in breast conserving surgery for moderate-to small-sized breast cancer.Methods From December 2014 to May 2017,thirty-eight moderate-to-small sized breast patients whose tumor was located in the lower pole of our hospital were included.According to the different application of incision in breast conserving surgery,the patients were divided into the two groups：crescent incision breast conserving group（observation group,n=18） and the inverted T shape incision breast conserving group（control group,n=20）.The breast volume,the tumor diameter,the amount of tissue excised,the proportion of tissue excised amount,the postoperative complications and the cosmetic effect in patients between the two groups were compred.Statistically analyzed was conducted with SPSS 19.0 software.Results Breast volume in the observation group was smaller than that of the control group,the proportion of tissue excised amount in the observation group was higher than that of the control group,and there was a statistical difference（P〈0.05）.The median follow-up period was 22 months（6-30 months）,in the observation group,there was 1 case of local flap ischemia but no necrosis at the early stage.There were 2 cases of local flap ischemic necrosis in the control group,it had no local recurrence and distant metastasis occurred in all the patients.There was no statistical difference in cosmetic effect between the two groups（P〉0.05）.Conclusion For breast cancer patients with tumor located in the lower pole,the tumor shaping method of crescent incision combined with abdominal advancement flap applied reasonably can achieve a good aesthetic effect.It is a simple and feasible procedure and it is worthy of promotion.