乳房皮下切除与自体组织即刻乳房再造  

Skin sparing incision mastectomy with immediate breast reconstruction

作　　者：刘立刚 张军林 方震[1] 王亮 傅建民 麦沛成[2] 

机构地区：[1]暨南大学第二临床医学院深圳市人民医院整形外科,深圳518020 [2]暨南大学第二临床医学院深圳市人民医院甲乳外科,深圳518020

出　　处：《中华医学美学美容杂志》2006年第6期346-349,共4页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：国务院侨办重点学科科研课题项目(编号:1998175)

摘　　要：目的探索乳房皮下切除与几种方法的乳房再造术,即腹直肌肌皮瓣或背阔肌肌皮瓣加乳房假体或局部皮瓣等即刻再造乳房的方法。方法选择乳腺导管内原位癌10例和巨大乳腺良性肿瘤5例,顺乳晕切口活检,病理检查确立诊断后,采用经乳腺切口行乳癌或巨大肿瘤的乳房皮下切除术,若乳癌或良性肿瘤体积较大,另于腋窝部加做顺腋下皱襞的附加切口,以便于取出切除的组织及切除乳腺的腋尾部,同时可以切取腋淋巴结行冰冻切片活检。然后,应用腹直肌肌皮瓣或背阔肌肌皮瓣加乳房假体或局部皮瓣即刻行再造乳房,充填乳房切除后的空间,仅以少量的肌皮瓣皮肤修复乳头、乳晕切除后的缺损,并在此转移皮瓣上再造乳头、乳晕。结果经过多专科协作共完成15例,随访结果良好,无肿瘤复发。此法再造的乳房易与健侧乳房对称,保留了原有乳房皮肤的良好感觉,外观形态自然,再造乳房瘢痕较少,且手术切口瘢痕隐蔽。结论在严格选择手术适应证防止乳腺癌复发的前提下,乳房皮下切除与即刻乳房再造法,对乳腺导管内原位癌和巨大乳腺良性肿瘤患者Ⅰ期完成肿瘤切除和乳房再造术,具有积极有效的意义。Objective To achieve the high quality of reconstructed breast for the patients with early stage breast cancer or huge breast benign tumor. Methods Patients with ductal carcinoma in situ （DCIS） or huge breast benign tumor were selected to undergo skin-sparing mastectomy. The previous biopsy incision was designed to be around the areola, and the preferred skin-sparing incision included the nipple-areola complex and a small margin around the biopsy site. If the breast tissue or breast benign tumor was huge, an axillary incision was performed to remove breast tissue or benign tumor and provide exposure for lymph node dissection. Autologous tissue was used to fill the skin envelope. The excised skin was replaced as precisely as possible by TRAM flap or latissimus dorsi musculocutaneous flap or local flap immediately, The pedicled TRAM flap, pedicled latissimus dorsi musculocutaneous flap and local flap had been used for 15 patients. The second stage operation of nipple areola recon struction was done on the new flap for 2 patients. Results The results of the skin-sparing breast re constructive technique were better than other techniques in breast shape, symmetry, skin colour, skin sensation and incision scar. One patient had partial necrosis of her breast envelope skin along the incision because of the thin sparing skin caused by mastectomy. The other patients in the group had good results. The follow-up period ranged from 8 months to 7 years. Conclusion Skin-sparing mastectomy with immediate autograft tissue breast reconstruction is an ideal reconstructive method for patients with DCIS or huge breast ben gn tumor.

关 键 词：乳房切除术 皮下 乳房再造术 乳腺导管内原位癌 

分 类 号：R655.8[医药卫生—外科学]