钛化聚丙烯网片在乳腺癌术后硅凝胶假体即刻假体乳房再造中的应用

Application of titanium-coated polypropylene mesh in immediate breast reconstruction with silicone prosthesis after breast cancer surgery

目的:探讨钛化聚丙烯网片(TCPM)在乳腺癌术后硅凝胶假体即刻乳房再造中的应用效果。方法:回顾性分析2016-2018年在我院行TCPM加硅凝胶假体即刻乳房再造的乳腺癌患者26例,其中保留皮肤的全乳切除术7例,保留乳头乳晕的全乳切除术19例,分析手术情况,术后效果,并发症及远期随访结果。结果:26例患者均成功完成手术,平均手术时间(78.46±5.96)min,平均术中出血量(73.85±17.68)m L,术后引流管拔除时间10~14 d。再造乳房外观评价"优良"率为88.46%(23/26)。术后即刻血清肿3例,经引流后好转。术后切口愈合不佳1例,经抗炎,换药,再次缝合后好转。1例术后3个月及5个月后反复自发性血清肿,经引流治疗后好转。1例因排斥反应取出假体及网片。所有患者随访5~21个月,无局部复发及远处转移患者。结论:TCPM在硅凝胶假体乳房再造中,可以提供一个安全有效的假体覆盖,简化手术流程,操作简便,在经济条件较好的患者中适合推广。

Objective:To assess the application efficacy of titanium-coated polypropylene mesh(TCPM)in immediate breast reconstruction with silicone prosthesis after surgery for breast cancer.Methods:The clinical data of 26 patients with breast cancer undergoing immediate breast reconstruction using TCPM combined with silicone prosthesis from 2016 to 2018 were retrospectively analyzed.Of the patients,skin sparing total mastectomy was performed in 7 cases,and nipple sparing total mastectomy was performed in 19 cases.The surgical variables,postoperative outcome,complications and long-term follow-up results were analyzed.Results:Operations were successfully completed in all of the 26 patients.The average operative time was(78.46±5.96)min,average intraoperative blood loss was(73.85±17.68)m L,and the time to postoperative tube removal was 10–14 d.The excellent/good rate of the appearance of the reconstructed breast reached 88.46%(23/26).Dorsal hematoma occurred in 3 cases immediately after operation,which were improved after drainage.Poor incision healing occurred in one case after operation,which was improved by anti-inflammatory treatment,dressing change and re-suture.Recurrent spontaneous seroma occurred in one case on 3 and 5 months after operation,which was relieved by drainage.The prosthesis and mesh were removed in one case due to rejection.Followed-up was performed for 5 to 21 months in all patients,and no local recurrence or distant metastasis was found in any of the patients.Conclusion:In breast reconstruction with silicone prosthesis,TCPM can provide safe and effective prosthesis coverage and simplify the operation process.It is suitable for use in patients who have favorable economic conditions.