背阔肌肌皮瓣在新辅助化疗后cT4局部晚期乳腺癌创面修复中的应用

Application of latissimus dorsi musculocutaneous flap to repair the partial defect of chest wall after neoadjuvant chemotherapy in the cT4 local advanced breast cancer patients

目的:探讨背阔肌肌皮瓣(LDMF)在新辅助化疗(NAC)后cT4局部晚期乳腺癌(cT4-LABC)创面修复中的应用效果。方法:回顾性分析2017年12月至2020年08月间我科收治14例cT4-LABC患者,在经过抗感染和NAC达到临床获益(PR+SD)后,局部行乳腺癌根治性切除术,并即刻应用LDMF修复胸壁缺损。结果:14例患者中13例(13/14,92.9%)完成既定周期的NAC,1例仅完成2周期NAC(剔除研究)。在纳入研究的13例患者中,无CR和PD病例,PR 12例(12/13,92.31%),SD 1例(1/13,7.69%),NAC临床获益率100%(13/13)。13例患者均成功完成手术,手术时间4~6小时,术中出血200~300 mL,术后2例皮肤缺血坏死(2/13,15.38%),通过换药自行愈合,拔管后8例供区出现少量血清肿(8/13,61.54%),通过抽液、加压包扎处理后消失。随访1~36个月,中位随访22个月,1例局部复发(1/13,7.69%)、3例远处转移(3/13,23.08%)、2例死亡(2/13,15.38%),所有患者背阔肌功能良好,上肢活动基本正常。结论:cT4-LABC在保证全身治疗有效后,局部手术时应用LDMF即刻修复胸壁缺损切实可行,效果确切,值得推广。

Objective:To investigate the effect of applying of the latissimus dorsi musculocutaneous flap(LDMF) to repair of the partial defect of chest wall after neoadjuvant chemotherapy(NAC) in the cT4local advanced breast cancer(cT4-LABC) patients.Methods:From December 2017 to August 2020,14 patients with cT4-LABC were retrospectively analyzed, who underwent local radical mastectomy of breast cancer after anti-infection and NAC achieved clinical benefit(PR+SD),LDMF was applied immediately to repair the defect of chest wall.Results:In the 14 patients, 13(13/14,92.9%) completed the established cycle of NAC,and 1 case completed only 2 cycles of NAC(elimination study).In the 13 patients included in the study, there were no CR and PD case, PR 12 cases(12/13,92.31%),SD 1 case(1/13,7.69%),according to the criteria of RECIST 1.1,NAC clinical benefit rate(CBR) was 100%(13/13).All the 13 patients successfully completed the operation.The operation time was 4~6 hours.The bleeding was 200~300 mL during the operation.The skin necrosis was found in 2 cases(2/13,15.38%) after the operation and were healed by changing the dressings, and a small amount of seroma were appeared in 8 cases(8/13,61.54%) after the extubation and were disappeared by drainaging and pressuring bandage treatment.Follow-up time was 1~36 months, median follow-up was 22 months.1 case had local recurrence(1/13,7.69%).3 cases had distant metastasis(3/13,23.08%).2 cases died(2/13,15.38%).Latissimus dorsi function was good in all patients.Upper limb movement was basically normal.Conclusion:It is feasible and effective to immediately use LDMF to repair partial defect of chest wall after effective clinical treatment in cT4-LABC patients.