旋转筋膜组织瓣技术在内侧象限乳腺癌保乳术中的临床应用

Clinical application of rotation fascia flap technique in breast conserving surgery from inner quadrant of breast cancer

目的探讨应用旋转筋膜组织瓣技术修复内侧象限乳腺癌保乳术后局部缺损的可行性及美容效果。方法回顾性分析2017年1月至2019年1月期间40例行保乳术的内侧象限乳腺癌患者临床资料,根据术式不同分为整形组和常规组,整形组20例采用旋转筋膜组织瓣修复局部缺损,常规组20例采用切缘周围筋膜组织瓣移位修复局部缺损。应用SPSS22.0统计软件分析,围术期各项指标等计量资料以(±s)表示,独立t检验;术后并发症、二次手术扩切率、皮瓣缺血坏死率、皮下脂肪液化率及乳房美学效果评价采用χ^2检验,以P<0.05为差异有统计学意义。结果两组患者均成功完成保乳手术,整形组患者在手术时间、术中出血量、手术切口长度及引流管留置时间均较常规组增加,但二次手术扩切率为0%明显低于常规组25.0%,差异均有统计学意义(P<0.05)。两组术后总并发症发生率、皮瓣坏死率及伤口皮下脂肪液化率比较,差异均无统计学意义(P>0.05)。术后评价美容效果显示整形组明显优于常规组(P=0.044)。术后随访12~36个月,中位随访24个月,无局部复发及远处转移。结论采用旋转筋膜组织瓣技术修复内侧象限乳腺癌保乳术后的局部缺损是可行的,手术操作性强、创伤小,切口隐蔽,术后美容效果好,值得临床推广。

Objective To explore the feasibility and cosmetic effect of rotation fascia flap technique in breast conserving surgery from inner quadrant of breast cancer.Methods The clinical data of 40 cases of inner quadrant breast cancer patients treated with breast conserving surgery from January 2017 to January 2019 were retrospectively analyzed.According to the operation methods,the patients were divided into plastic group and routine group.In the plastic group,20 case of patients treated with rotation fascia flap technique.In the routine group,20 case of patients treated with the fascial flap around the cutting edge.All data were analyzed by SPSS 22.0 statistical software.The measurement data of perioperative indicators and were presented as and by t test.The incidence of postoperative complications,secondary surgery enlarged rate,fascia flap necrosis rate,subcutaneous fat liquefaction rate and breast cosmetic effect evaluation were compared between two groups by chi square test.P<0.05 means that there was difference in statistics.Results Both groups of patients successfully completed breast-conserving surgery.The plastic group patients had significantly increased in operation time,operative blood loss,incision length and drainage tube indwelling time compared with the routine group,the rate of secondary surgery enlarged was 0%,which was significantly lower than that of routine group,which was 25.0%.the difference was statistically significant(P<0.05).There were no statistically significant difference in the incidence of total postoperative complications,the rate of necrosis of skin flap and the rate of subcutaneous fat liquefaction in the wound(P>0.05).The evaluation of postoperative cosmetic effect showed that the plastic group was significantly better than routine group,the difference was statistically significant(P=0.044).All patients were followed up for 12 to 36 months with the average time of 24 months,and local recurrence and distant metastasis were not observed.Conclusion The rotation fascia flap technique for filling local defects in inner quadrant of breast cancer was feasible,easy to operate,smaller trauma,hidden incision scar,better cosmetic effect and worthy of clinical promotion.