前锯肌筋膜联合部分胸大肌筋膜脂肪瓣在乳房再造中的临床应用

Clinical application of serratus anterior muscle fascia combined with partial pectoralis major fascia fat flap in breast reconstruction

目的:探讨在即刻假体乳房再造中,前锯肌筋膜联合部分胸大肌筋膜脂肪瓣覆盖假体的临床应用价值。方法:选择2017年8月至2020年8月临沂市肿瘤医院收治的50例进行假体即刻乳房再造乳腺癌患者,其中31例采用前锯肌筋膜联合部分胸大肌筋膜脂肪瓣覆盖假体外下极(SPMF组),19例采用背阔肌肌瓣覆盖假体外下极(LDMF组)。对比两组手术时长、术后引流管放置天数、术后住院天数、切口并发症发生率、再造乳房形态和患者生活质量的差异。结果:SPMF组患者手术时长较短、术后引流管留置时间较短、住院时间更短(P<0.05)。SPMF组患者与LDMF组患者再造乳房形态及切口并发症发生率差异无统计学意义。SPMF组患者术后生活质量明显优于LDMF组(P<0.05)。结论:乳房重建中,前锯肌筋膜联合部分胸大肌筋膜脂肪瓣覆盖假体较背阔肌肌瓣覆盖假体手术时长短,患者术后恢复较快、生活质量较高,值得推广。

Objective:To investigate the clinical value of serratus anterior muscle fascia combined with partial pectoralis major fascia fat flap in immediate prosthetic breast reconstruction.Methods:From August 2017 to August 2020,a total of 50 patients with breast cancer in the mastopathy department of Linyi Cancer Hospital received immediate prosthetic breast reconstruction.Among them,serratus anterior muscle fascia combined with partial pectoralis major fascia fat flap was used to cover the outer bottom of the breast implant in 31 patients(SPMF group),latissimus dorsi muscle flap was used to cover the outer bottom of the breast implant in 19 patients(LDMF group).The operation time,drainage tube removal time,discharge time,incision complications,breast cosmetic effect and quality of life of the patients were compared between the two groups.Results:Patients in the SPMF group had a significantly shorter operation time,shorter drainage tube placement time,and shorter hospital stay(P<0.05).There was no significant difference in cosmetic effect and incidence of incision complications between the two groups.The quality of life in the SPMF group was significantly better than that in the LDMF group(P<0.05).Conclusions:For the cover of the outer bottom of the breast implant during the immediate prosthetic breast reconstruction,compared with the latissimus dorsi muscle flap,serratus anterior muscle fascia combined with partial pectoralis major fascia fat flap has the advantages of shorter operation time,quicker recovery,and higher quality of life after surgery,and it is worth of wide promotion.