局部旋转皮瓣在中央区乳腺癌保乳术中的应用

Application of local rotation flap for breast conservation in central breast cancer

目的:探讨局部皮下蒂组织瓣旋转修复中央区乳腺癌保乳术后中央区缺损的效果。方法:2017年1月至2018年12月,江西省乳腺专科医院乳腺一科收治的Ⅰ、Ⅱ期中央区乳腺癌患者,均实施保乳手术,并以局部皮下蒂组织瓣旋转修复乳腺中央区缺损。术后随访观察并发症情况,评估术后1年患侧乳房的美容效果、患者满意度、患者舒适度及术后2年局部肿瘤复发、转移情况。结果:研究共纳入14例中央区乳腺癌患者,均为女性,年龄37~75岁,中位年龄47岁。保乳术后创面一期愈合12例,切口感染1例、皮瓣坏死1例,均二期缝合。术后1年胸骨上切迹到乳头的距离患侧为(22.27±2.38)cm、健侧为(23.33±2.22)cm,差异无统计学意义(t=-1.253,P=0.242);乳头到胸骨中线的距离患侧为(10.12±0.91)cm、健侧为(10.68±1.09)cm,差异无统计学意义(t=-1.937,P=0.094);乳头到乳房下皱壁的距离患侧为(6.94±0.95)cm,健侧为(7.05±1.30)cm,差异无统计学意义(t=-0.478,P=0.645)。术前患侧乳房满意度为(60.2±11.4)分,术后为(61.7±12.7)分,术前、后比较差异无统计学意义(t=-0.330,P=0.744);术后整体舒适度为(62.05±4.40)分,为中度舒适,其中生理舒适度为(6.52±2.05)分、精神心理舒适度为(15.13±2.56)分、社会舒适度为(19.09±1.57)分、环境舒适度为(21.29±2.11)分。术后2年局部无肿瘤复发,无全身转移。结论:局部皮下蒂组织瓣旋转修复中央区乳腺癌保乳术后中央区缺损,术后并发症少,乳房美容效果良好,术后患者满意度好,中度舒适,肿瘤学安全性好。

To investigate the application of local rotation flap with subcutaneous pedicle for breast conservation in central breast cancer.Methods Retrospective analysis of clinical data of 14 patients with stageⅠorⅡcentral breast cancer was performed.The local rotation flap with subcutaneous pedicle was used for breast conservation in Jiangxi Provincial Breast Specialist Hospital(Nanchang Third Hospital)from January 2017 to December 2018.The postoperative complications were recorded.One year after operation,the aesthetic result,satisfactory and comfort index were evaluated.Two years after operation,local tumor recurrence and metastasis were followed.Results All patients were women,aged 37-75 years old with the median age as 47.First-stage healing was achieved in 12 patients.Wound infection happened in one case and necrotic in one case.They were all healed after secondary suture.Fourteen patients were followed up for 1 year,the suprasternal notch-nipple length was(22.27±2.38)cm at the operative side,and(23.33±2.22)cm at the healthy side,showing no statistical significance(t=-1.253,P=0.242).The nipple-midsternal line length was(10.12±0.91)cm at the operative side,and(10.68±1.09)cm at the healthy side,showing no statistical significance(t=-1.937,P=0.094).The nipple-inframammary fold length was(6.94±0.95)cm at the operative side,and(7.05±1.30)cm at the healthy side,showing no statistical significance(t=-0.478,P=0.645).The patient’s breast satisfaction was 60.2±11.4 points before operation and 61.7±12.7 points after operation,with no difference between them(t=-0.330,P=0.744).The overall postoperative comfort index was 62.05±4.40 points,which indicates a moderate comfort state.The physiological comfort index was 6.52±2.05 points,the mental and psychological comfort index was 15.13±2.56 points,the social comfort index was 19.09±1.57 points,and the environmental comfort index was 21.29±2.11 points.There was no local recurrence and no systemic metastasis 2 years after operation.Conclusions The breast conservation in central breast cancer with local rotation flap with subcutaneous pedicle is less invasive with few complication and satisfactory results in cosmetic appearance.The moderate comfort index and good prognosis can be prospected.