背阔肌皮瓣修复在乳腺癌保乳手术中的应用  

Application of latissimus dorsi muscle flap for breast conservation in breast cancer

作　　者：刘君[1] 方志沂[1] 肖春花[1] 王斌[1] 顾林[1] 

机构地区：[1]天津医科大学附属肿瘤医院乳腺科、乳腺癌防治教育部重点实验室天津市肿瘤防治重点实验室, 300060

出　　处：《中华肿瘤杂志》2011年第4期305-307,共3页Chinese Journal of Oncology

摘　　要：目的探讨采用背阔肌皮瓣修复乳腺癌部分乳房切除术后较大范围缺损的治疗和美容效果。方法24例乳腺癌患者的肿瘤最大径为3．0～5．5cm，平均3．5cm。均行保留乳房的病灶广泛切除，所有患者均在术中冰冻切片确定切缘达阴性后，即刻采用背阔肌皮瓣修复局部缺损，术后给予全乳放射治疗±辅助化疗±内分泌治疗。结果全组24例患者背阔肌皮瓣全部成活，背部及乳房皮肤无坏死。术后中位随访23个月，患者均无病生存。全乳放射治疗对转移的背阔肌皮瓣未见明显影响，乳房外观优良率为79．2％，患者主观评价满意度为96．O％。结论采用转移的背阔肌皮瓣修复部分乳房切除术后的较大缺损可获得满意的治疗效果和美容效果，对存在导管内癌、新辅助化疗后、乳房中央区（乳头乳晕区）及较大肿瘤（〉3cm）等保乳手术相对或绝对禁忌的患者可行保乳手术，扩大了保乳手术的适应证。Objective Breast conserving surgery （BCS） is one of standard treatment approaches in early breast cancer. Although most defect after BCS can be repaired, the cosmetic outcomes are unsatisfactory in the patients with poor tumor/breast ratio. Oncoplastic surgery （OPS） has emerged as a new approach for providing adequate tumor resection without compromise of aesthetic outcomes in BCS. Our purpose is to explore the cosmetic outcomes of applying latissimus dorsi （LD） muscle flap to reshape severe breast conservation deformities in breast cancer. Methods Totally 24 cases of breast cancer were studied. The tumor size was 3.0-5.5 cm （ median 3.5 cm）. All the cases underwent BCS and achieved negative margin by frozen sections examination. Then LD flap reshaping were performed. All the patients received whole breast radiotherapy ＋ chemotherapy ± endocrine therapy. Results All the LD flaps were alive without skin necrosis. After a median 23-month follow-up, all the cases were disease-free surviving. The whole breast radiotherapy had no significant effect on the LD flaps. The rate of good cosmetic results was 79.2%. The subjective satisfactory rate of the patients was 96%. Conclusions Both satisfactory aesthetic outcome and good treatment effect were obtained using LD flap to reshape severe breast conservation deformity. OPS offers tools for breast conservation in patients otherwise destined for mastectomy or poor aesthetic outcome, such as large tumor/breast ratio, nipple-areola complex tumor, ductal carcinoma in situ, neoadjuvant chemotherapy cases and so on.

关 键 词：乳腺肿瘤 保乳手术 背阔肌皮瓣 修复外科手术 

分 类 号：R737.9[医药卫生—肿瘤]