扩大背阔肌皮瓣联合乳腺癌精准手术在一期乳房再造的效果

Effects of extended latissimusdorsi musculocutaneous flap combined with precision surgery for breast cancer in stage Ⅰ breast reconstruction

目的探讨扩大背阔肌肌皮瓣联合乳腺癌精准手术在一期乳房再造的效果。方法2022年1月至2023年2月,连云港市妇幼保健院乳腺保健科收治12例女性乳腺癌患者,年龄27~50岁,中位年龄45岁。肿瘤位于右外上象限3例、外下象限1例、左内上象限1例、左内下象限2例、左外上象限1例、左外下象限4例;肿瘤最大径1.5~3.5cm。12例患者均采用扩大背阔肌肌皮瓣联合乳腺癌精准手术实施一期乳房再造,其中9例行保留乳头乳晕的单纯乳房切除,带皮岛转移皮瓣6例。观察手术效果及术后并发症,根据Harris标准对再造乳房美容效果进行评估,术后随访4~16个月。结果12例均成功行扩大背阔肌肌皮瓣乳房再造,皮瓣成活率100%。1例背部切口局部皮缘坏死,1例乳头部分缺血坏死,5例出现背部供区积液。再造乳房美容效果Harris评估为优3例、良6例、一般3例。随访4~16个月(中位数12个月),无局部复发及远处转移。结论乳腺癌行扩大背阔肌肌皮瓣联合乳腺癌精准切除术一期再造,乳房形态效果较好,手术操作简便,是一种安全可行的治疗方法。

Objective To evaluate the application value of extended latissimusdorsi musculocutaneous flap combined with breast precision hand in stage Ⅰ breast reconstruction.Methods Twelve cases of extended latissimusdorsi musculocutaneous flap combined with stage Ⅰ breast reconstruction for breast cancer precision surgery were collected from January 2022 to February 2023 in our department,the postoperative complications of surgical techniques were analyzed,and the cosmetic effects of breast reconstruction were evaluated according to Harris standards.Results All 12 cases underwent breast reconstruction with extended latissimusdorsi musculocutaneous flap,and the survival rate of the flap was 1o0%.There was local cutaneous margin necrosis in 1 case of back incision,partial ischemic necrosis of the nipple in 1 case,and effusion in the donor area of the back in 5 cases.Harris evaluation of cosmetic effect of breast reconstruction was excellent in 3 cases,good in 6 cases,and fair in 3 cases.Follow-up time was 4-16 months(median was 12 months),and no local recurrence or distant metastasis was observed during follow-up.Conclusions The extended latissimusdorsi musculocutaneous flap combined with precision mastectomy stage I reconstruction is a safe and feasible treatment method for breast cancer.