带蒂脂肪瓣在保乳术后局部缺损整形修复中的应用  

Application of pedicle fat flap for defect repair in breast-conserving surgery of breast cancer

作　　者：刘君[1] 林杰[2] 郝雅婷[1] 杨艳芳[1] 方志沂[1] 顾林[1] 

机构地区：[1]天津医科大学附属肿瘤医院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 [2]福建省三明市中西医结合医院

出　　处：《中华医学杂志》2012年第48期3420-3422,共3页National Medical Journal of China

摘　　要：目的评价采用乳房皱襞下带蒂脂肪瓣修复乳腺癌保乳手术后缺损的疗效。方法自2009年5月至2011年7月对天津医科大学附属肿瘤医院18例乳腺癌患者行保留乳房的局部广泛切除术，随后采用乳房皱襞下带蒂脂肪瓣修复局部缺损。全组均为女性，年龄33—59岁（中位43岁），肿瘤均位于乳房下方象限，最大径为2．0—3．0cm（平均2．5cm），术后给予全乳放射治疗及辅助化疗，并对其中10例雌激素受体阳性的患者行内分泌治疗。术后第1个月、辅助化疗完成后及全乳放疗后门诊各随访1次，观察手术后局部美容效果及放化疗对局部的影响，观察双侧乳房是否对称、有无水肿、坏死或瘢痕挛缩等情况，以后每4个月门诊随访1次观察局部复发及美容效果。结果全组18例脂肪瓣全部成活，术后中位随访15个月，全部无病生存。2例出现脂肪液化，全乳放射治疗对脂肪瓣未见明显影响，乳房外观优良率88．9％，患者主观评价满意度为100．0％。结论采用乳房下皱襞带蒂脂肪瓣修复保乳手术后的局部缺损可以获得满意的治疗效果和美容效果。Objective To evaluate the cosmetic outcomes of applying pedlcle tat tlap below breast fold for repairing inferior quadrant defect in breast-conserving surgery. Methods From May 2009 to July 2011, 18 cases of breast cancer at our hospital were recruited. All cases underwent breast-conserving procedures and achieved negative margin by frozen section examination. Then pedicle fat flap below breast fold was applied to reshape breast defect. All of them were of females with a median age of 43 years （ range ： 33 -59）. The median tumor size was 2. 5 cm （range： 2. 0 -3.0）. All tumors were located at the inferior quadrant of breast. All of them received whole breast radiotherapy and adjuvant chemotherapy. And 10 cases with positive estrogen receptor had adjuvant endocrine therapy. They were followed up at one-month postoperatively. Upon the completion of chemotherapy and radiotherapy, then follow-up was once every 4 months. The cosmetic outcomes and disease relapse were observed. Results All pedicle fat flaps survived without necrosis. After a median follow-up period of 15 months, all survived disease-free. Fat liquefaction was observed in 2 cases. The whole breast radiotherapy had no significant effect on pedicle fat flap. The rate of good cosmetics was 88.9%. And their subjective satisfactory rate was 100. 0%. Conclusion Both satisfactory aesthetic outcome and good efficacy are obtained with pedicle fat flap below breast fold for tumors located at the inferior quadrant of breast.

关 键 词：乳腺肿瘤 乳房成形术 乳房皱襞下带蒂脂肪瓣 修复外科手术 

分 类 号：R737.9[医药卫生—肿瘤]