乳腺癌术后带蒂降支背阔肌肌皮瓣即刻乳房重建临床效果研究

Application of latissimus dorsi flap with peduncle in immediate breast cancer breast reconstruction

目的探讨带蒂降支背阔肌肌皮瓣用于乳腺癌即刻乳房重建术的临床效果和价值。方法回顾性分析2021年1月至2022年6月新疆医科大学附属肿瘤医院乳腺外科收治的25例乳腺癌根治术后行带蒂降支背阔肌肌皮瓣即刻乳房重建病人(带蒂降支组)的临床资料,并与同期使用传统背阔肌肌皮瓣进行即刻乳房重建的28例病人(常规组)进行比较,评估临床效果并进行随访观察。结果带蒂降支组与常规组在住院时间[(5.7±1.0)d vs.(6.5±1.1)d]、术后带管时间[(10.4±4.5)d vs.(14.9±5.7)d]差异具有统计学意义(P=0.007、0.002)。带蒂降支组2例病人背部术区发生血清肿,经局部注射器抽吸后好转,常规组病人5例背部术区发生血清肿,2例拔管后再次置管致引流时间延长。随访至2024年4月,带蒂降支组1例病人放疗后3个月出现局部肿瘤复发。结论带蒂降支背阔肌皮瓣即刻乳房重建手术美容效果好、损伤小,但对于首诊皮肤侵犯或新辅助化疗后效果一般的乳腺癌病人应慎重选择。

To investigate the effect and value of latissimus dorsi flap with descending branch for immediate breast reconstruction for breast cancer.Methods We retrospectively analyzed the clinical data of 25 patients admitted to our hospital from January 2021 to June 2022 who underwent immediate breast reconstruction using the tibial descending latissimus dorsi muscle flap for breast cancer(tibial descending group)and compared them with 28 patients who underwent immediate breast reconstruction using the traditional latissimus dorsi muscle(conventional group)during the same period to assess the clinical effects and conduct follow-up The clinical results were evaluated and followed up.Results The hospitalization time of the patients in the group with descending branch was(5.7±1.0)d,and the time of extubation was(10.4±4.5)d after the operation;the hospitalization time of the patients in the conventional group was(6.5±1.1)d,and the time of extubation was(14.9±5.7)d after the operation.In the group with the descending branch,seroma occurred in the back of 2 patients,which was improved after local syringe aspiration,while in the conventional group,seroma occurred in the back of 5 patients,and in 2 cases,drainage time was prolonged by the reintroduction of tubes after extubation.Patient satisfaction was higher in the banded descending branch group than in the conventional group.Until April 2024,one patient in the banded descending branch group had local tumor recurrence 3 months after radiotherapy.Conclusion Immediate breast reconstruction with a tipped descending latissimus dorsi flap is cosmetically effective,minimally injurious,but it should be chosen with caution in patients with a first diagnosis of cutaneous invasion or an average outcome after neoadjuvant chemotherapy.