局部晚期乳腺癌根治切除联合全厚邮票植皮术一期创面修复的临床研究

Clinical study of radical excision combined with one-stage full-thickness stamp skin grafting for wound healing in locally advanced breast cancer

目的探讨局部晚期乳腺癌(LABC)根治切除联合自体全厚邮票植皮术一期创面修复的疗效。方法回顾性分析2018年3月至2020年3月首都医科大学附属北京安贞医院收治的10例LABC女性患者的临床资料。9例原发肿瘤直径> 5 cm,在切除肿瘤后取下腹部皮肤行一期全厚邮票植皮术;1例为右侧改良根治术后2年局部复发4个月伴随对侧原发乳腺癌,切除右侧胸壁复发病灶后,取左侧改良根治术所切除乳房的正常皮肤行一期全厚邮票植皮术。记录术后7 d植皮区成活、皮下积液情况。术后随访6~24个月,记录植皮区皮肤状态及复发情况。结果 10例患者行乳腺癌根治手术联合一期全厚邮票植皮术修复胸壁缺损创面,手术效果满意,供皮区无张力缝合,愈合良好,术后7 d植皮区95%以上成活。随访6~24个月,植皮区皮肤弹性好,瘢痕轻,耐摩擦;9例患者无局部复发及远处转移;1例术后拒绝辅助化疗及放疗,术后1年同侧胸壁出现局部复发,未发现其他转移。术后患者生活质量明显改善。结论乳腺癌根治术联合全厚邮票植皮术一期创面修复治疗LABC手术效果满意,并可有效地降低皮瓣坏死风险,促进切口Ⅰ期愈合,为需要植皮治疗的LABC患者提供了安全、可靠的手术方法。

Objective To investigate the curative effect of radical excision combined with autologous one-stage full-thickness stamp skin grafting for wound healing in locally advanced breast cancer( LABC).Methods From March 2018 to March 2020,clinical data of 10 female patients with LABC admitted to Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed. There were 9 cases with primary tumors diameter > 5 cm who underwent one-stage full-thickness skin grafting after tumor resection,using lower abdominal skin. One case was local recurrence for 4 months,performed modified radical mastectomy for right before 2 years,and accompanied by contralateral primary breast cancer undergoing one-stage full-thickness skin grafting after resection,using the normal skin of the left breast after modified radical mastectomy. The survival of the skin grafting and subcutaneous fluid accumulation occurred 7 d after surgery were recorded. Status of skin grafting and recurrence were recorded during 6-24 months of follow-up. Results Ten cases underwent radical mastectomy combined with one-stage full-thickness stamp skin grafting to repair the wound on chest wall. The surgical effect was satisfactory. The donor site was sutured without tension and healed well. More than 95% of the skin grafting area survived. During 6-24 months of follow-up,the skin in the skin grafting area had good elasticity,light scar and friction resistance. Nine cases had no recurrence or conversion move,and 1 case who refused adjuvant chemotherapy and radiotherapy after operation had ipsilateral local chest wall recurrence without conversion move 1 year after operation. The quality of life of the patient was significantly improved after operation. Conclusions Radical mastectomy combined with one-stage full-thickness stamp skin grafting for wound healing has satisfactory effect on treating LABC. It can effectively reduce the risk of flap necrosis,promote the primary healing of the incision on the premise of ensuring the surgical effect,and provide a safe and reliable surgical method for LABC patients who need skin grafting treatment.