早期乳腺癌保留乳头乳晕复合体的改良根治术——Ⅰ期腹直肌肌皮瓣重建乳房

Modified Radical Operation for Early Breast Cancer for Preserving Nipple-Areo lar Complex and Breast Reconstruction Using Transverse Rectus Abdominis Myocutan eous (TRAM) Flap

背景与目的:改良根治术目前已成为早期乳腺癌主要外科治疗方法之一,但术后如何重建乳房及保留乳头乳晕复合体一直是争论的焦点。本研究探讨早期乳腺癌保留乳头乳晕复合体的改良根治术———Ⅰ期腹直肌肌皮瓣重建乳房的方法及临床应用。方法:对早期乳腺癌患者行皮下乳腺切除,腋窝淋巴结清除,腹直肌肌皮瓣Ⅰ期乳房再造,最大限度地保留乳房皮肤以及乳头乳晕复合体。结果:应用该方法治疗10例早期乳腺癌,术后随访24～48个月,所有病例均无肿瘤局部复发及远处转移,重建乳房外形良好,乳头乳晕区皮肤无坏死,皮肤无明显萎缩、变硬,半年后乳头感觉恢复,供区无腹壁疝形成。结论:保留乳头乳晕复合体的乳腺癌改良根治术———Ⅰ期腹直肌肌皮瓣重建乳房,外形效果良好,对早期乳腺癌要求保持乳房外形的患者可能是一种较好的治疗方法;因本研究例数较少,该技术的疗效有必要行更大样本的研究来证实。

BACKGROUND &OBJECTIVE: Modified radical mastectomy (MRM) operation has become an important surgical therapy for early stage breast cancer, but how to reconstruct breast and preserve nipple-areolar complex (NAC) is controversia l. In this study, we applied a modified radical mastectomy for early stage breas t cancer for preserving NAC and breast reconstruction using transverse rectus ab dominis myocutaneous (TRAM) flap. METHODS: During operation we performed the sub cutaneous glandular excision and axillary dissection, and reconstructed the brea st using TRAM flap in 10 patients with early stage breast cancer; meanwhile, max imam extent of breast skin and NAC were preserved. RESULTS: The appearance of th e reconstructed breast was better preserved after operation. No local recurrence and distant metastasis occurred in the patients during the follow up time (rang e 2448 months). No skin flap necrosis, atrophy, and scleroses surround the NAC were observed; and no abdominal wall hernia occurred at the donor site. The nip ple sensation was recovered half a year after surgery. CONCLUSION: Modified radi cal operation for preserving NAC and breast reconstruction using TRAM flap may b e a better way for breast cancer patients in early stage who request well preser ving of breast. More samples are needed for proving the effects of this operatio n.