乳腺癌术后植入物乳房重建两步法的应用探讨

Application of two-stage implant-based breast reconstruction after breast cancer surgery

目的:探讨乳腺癌术后两步法植入物乳房重建的手术疗效及临床应用价值。方法:回顾性分析2018年1月—2020年12月首都医科大学附属北京同仁医院乳腺中心完成保留乳头乳晕复合体或保留皮肤的皮下腺体全切除、一期置入皮肤扩张器,接受放疗后完成永久假体置换的乳腺癌患者共32例,记录患者的手术时间、置换手术与放疗的间隔时间、假体体积、扩张器内0.9%氯化钠溶液体积与假体体积差值、术后引流管保留时间、置换术后乳房外形满意度及并发症情况。结果:手术时间平均为(67.81±19.71) min;置换手术与放疗时间间隔平均为(9.88±2.00)个月;扩张器内0.9%氯化钠溶液体积平均为(225.47±56.83) mL,假体体积平均为(259.06±70.88) mL,假体体积与扩张器内0.9%氯化钠溶液体积差值平均为(33.59±14.88) mL;假体较扩张器增加的体积比例平均为(13.65±5.19)%;术后引流管保留时间平均为(9.03±1.40) d;置换术后乳房外形的满意度:优良23例(71.9%),一般8例(25.0%),差1例(3.1%);术后并发症:切口脂肪液化裂开1例(3.1%),血清肿2例(6.3%),未出现假体外露、取出等严重并发症。结论:对于乳房切除术后植入物乳房重建且需要放疗的乳腺癌患者,选择"针对扩张器放疗"的两步法,在放疗后6个月以上进行永久性假体置换手术的安全性好,同时通过松解包膜、重建乳房下皱襞以及必要的健侧乳房整形手术,可以达到更好的对称性和美学效果。

Objective:To investigate the efficacy and clinical value of two-stage implant-based breast reconstruction after total mastectomy for breast cancer patients.Methods:Thirty-two patients with breast cancer,who underwent nipple-sparing mastectomy or skin-sparing mastectomy,primary skin expander implantation,and permanent implant replacement after radiotherapy from January 2018 to December 2020 in the Breast Center,Beijing Tongren Hospital,Capital Medical University were analyzed retrospectively.Record the operation time of the patient,the interval between replacement surgery and radiotherapy,prosthesis volume,the difference between the volume of 0.9%sodium chloride solution in the dilator and the volume of the prosthesis,the retention time of the postoperative drainage tube,the satisfaction of the breast shape and the complications after the replacement.Results:The average operation time was(67.81±19.71)min;the average time interval between replacement surgery and radiotherapy was(9.88±2.00)months;the average volume of 0.9%sodium chloride solution in the dilator was(225.47±56.83)mL,and the average prosthesis volume was(259.06±70.88)mL,the average difference between the volume of the prosthesis and the volume of 0.9%sodium chloride solution in the dilator was(33.59±14.88)mL;the volume of the prosthesis is increased by an average of(13.65±5.19)%compared with the dilator;the average time of drainage tube retained after the operation was(9.03±1.40)d;satisfaction with breast shape after replacement:excellent in 23 cases(71.9%),general in 8 cases(25.0%),poor in 1 case(3.1%);postoperative complications:incision fat liquefaction 1 case of dehiscence(3.1%),2 cases of seroma(6.3%),no serious complications such as external exposure and removal of the prosthesis.Conclusions:For patients with breast cancer,who need breast reconstruction after mastectomy,the two-stage implant-based breast reconstruction in which the replacement operation will be carried out more than 6 months after radiotherapy is safe.Moreover,achieve better symmetry and aesthetic effect by releasing the capsule,reconstructing the inframammary fold,and necessary plastic surgery of the contralateral breast.