早中期乳腺癌保留乳头乳晕改良根治术后离断背阔肌止点扩大肌皮瓣Ⅰ期乳房再造术的临床效果  

Clinical Efficacy of Immediate Breast Reconstruction with Extended Latissimus Dorsi Musculocutaneous Flap after Nipple and Areola Sparing Modified Radical Mastectomy for Patients with Early-Middle Breast Cancer

作　　者：周韬[1] 黄平[1] 莫军扬[1] 庄亚强[1] 

机构地区：[1]广西柳州市人民医院乳腺甲状腺外科,广西柳州545006

出　　处：《中国普外基础与临床杂志》2014年第2期212-216,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨早中期乳腺癌行保留乳头乳晕改良根治术后使用扩大背阔肌肌皮瓣Ⅰ期乳房再造治疗的应用价值及临床效果。方法我院2009年11月至2012年10月期间收治的60例经临床穿刺活检病理明确诊断为早中期的乳腺癌患者按术式分为2组:乳房再造组(30例),即保留乳头乳晕乳腺癌改良根治术后离断背阔肌止点扩大肌皮瓣Ⅰ期乳房再造术;对照组(30例),即行传统乳腺癌改良根治术。比较2组患者的术后并发症,近远期疗效,生活质量,复发转移情况。结果①对照组完全患侧乳房缺失;乳房再造组乳房再造术均获得成功,再造乳房美容效果评价优22例,良7例,一般1例。②2组患者术后皮下积液、皮瓣坏死及患肢活动受限情况比较差异无统计学意义(P>0.05);术后切口拆线时间、术区引流时间、住院时间及术后化疗开始时间差异均无统计学意义(P>0.05)。③乳房再造组心理压力出现率及对第二性征不满意率明显低于对照组(P<0.001),乳房再造组社会交往适应率明显高于对照组(P<0.001)。④2组患者随访12~38个月(平均25个月),其中对照组有1例死亡,其余59例患者均未发现有局部复发和远处转移。结论从本组有限的数据初步看,乳腺癌根治术后离断背阔肌止点扩大肌皮瓣Ⅰ期乳房再造术,可在根治肿瘤的基础上获得满意的乳房美容效果,使患者的生活质量明显提高,该术式术后并发症较少,不影响乳腺癌的术后辅助放化疗和近远期疗效。Objective To explore the clinical efficacy of immediate breast reconstruction with extended latissimus dorsi musculocutaneous flap after nipple and areola sparing modified radical mastectomy for patients with early-middle breast cancer. Methods Sixty patients diagnosed with early-middle breast cancer by needle biopsy from November 2009 to October 2012 in this hospital were divided into two groups according to the surgical method. The breast reconstruction group （30 cases） were performed immediate breast reconstruction with extended latissimus dorsi musculocutaneous flap after nipple and areola sparing modified radical mastectomy, the control group （30 cases） were performed traditional modified radical mastectomy. The postoperative complications, clinical efficacy, quality of life, and recurrence and metastasis were compared in two groups. Results （3~） The ipsilateral breast was completely missing in the control group. The aesthetic effect in the breast reconstruction group was satisfactory including excellent in 22 patients, good in 7 patients, general in 1 patient. ①The rates of flaps effusion, flap necrosis, and affectied limb activity limitation had no significant differences in two groups （P^0.05）. The wound healing time, operation area drainage time, hospital stay, and post- operative chemotherapy start time all had no significant differences in two groups （P〈0. 05）. ② The frequency of psycho- logical pressure （inferiority/anxiety/fear） and rate of un-satisfaction of secondary sexual characteristics （body/curve） inthe breast reconstruction group were lower than those in the control group （P〈 0. 001）. The rate of social interaction fitness in the breast reconstruction group was higher than that in the control group （P〈0. 001）. ③ The following-up time was 12 to 38 months with an average 25 months, one case died because of brain metastasis in the control group, the rest 59 patients had no local recurrence and distant metastasis. Conclusions The immediate breast re

关 键 词：乳腺癌 扩展型背阔肌肌皮瓣 一期乳房再造 乳腺癌改良根治术 

分 类 号：R737.9[医药卫生—肿瘤]