乳腺癌根治术后即刻行扩大背阔肌肌皮瓣乳房再造50例分析

Analysis of 50 cases of breast reconstruction with expanded latissimus dorsi musculocutaneous flap immediately after radical mastectomy

目的探讨保留乳头、乳晕的乳腺癌改良根治术后即刻行扩大背阔肌肌皮瓣乳房再造的治疗及美容效果。方法收集2014年4月至2019年4月收治的50例乳腺癌患者临床资料,所有患者均采用保留乳头、乳晕(NSM)或保留皮肤(SSM)的乳腺癌改良根治术联合扩大背阔肌肌皮瓣乳房再造,观察手术相关指标(手术时间、手术出血量及引流管留置时间)及术后并发症情况,并评价术后美容效果。结果50例患者均成功完成保留乳头、乳晕或保留皮肤的乳腺癌改良根治术后即刻乳房再造术,皮瓣存活率100%,乳腺组织切除量(200±50)g,手术时间(220±40)min,手术出血量(35±15)mL,胸部引流管留置(12±4)d,背部引流管留置(20±5)d。其中,2例患者术后1个月存在背部血清肿,经重新置管引流后消除;1例患者术后出现乳头部分缺血坏死,经换药后愈合;1例患者术后出现上肢活动受限,经功能锻炼后缓解。美容效果评价显示,再造乳房优良率92%。所有患者随访36~60个月(中位数48个月),均未见局部复发及远处转移。结论乳腺癌改良根治术后即刻行扩大背阔肌肌皮瓣乳房再造术适合亚洲女性的中、小型乳房,手术可操作性强,美容效果好,值得临床推广。

Objective To investigate the efficacy and cosmetic effect of immediate breast reconstruction with expanded latissimus dorsi myocutaneous flap after modified radical mastectomy with nipple and areola preserved.Methods Clinical data of 50 patients with breast cancer from April 2014 to April 2019 were retrospectively analyzed.The operation was modified radical mastectomy with nipple and areola sparing or skin sparing and breast reconstruction with extended latissimus dorsi myocutaneous flap.The operative related indexes(operative time,operative blood loss and drainage tube indwelling time)and postoperative complications were observed,and the postoperative cosmetic effect was evaluated.Results Modified radical mastectomy and breast reconstruction were successfully completed in 50 patients,and the survival rate of skin flap was 100%.The amount of breast tissue resection was(200±50)g,the operative time was(220±40)min,the operative blood loss was(35±15)mL,the indwelling time of chest drainage tube was(12±4)d,and the indwelling time of back drainage tube was(20±5)d.Two patients had seroma on the back one month after operation,which disappeared after re-drainage.One patient appeared partial ischemic necrosis of the nipple after operation,which healed after dressing change.One patient had limited upper limb movement,which was relieved after functional exercise.The evaluation of cosmetic effect showed that the excellent and good rate of reconstructed breast was 92%.All patients were followed up for 36-60 months,with a median follow-up of 48 months.No local recurrence or distant metastasis was observed.Conclusion Breast reconstruction with immediate expanded latissimus dorsi musculocutaneous flap after modified radical mastectomy is suitable for small and medium sized breast of Asian women,with strong operability and good cosmetic effect,and is worthy of clinical promotion.