经胸大肌外下方前锯肌筋膜切口在硅凝胶假体乳房再造中的应用  

Application of incision of fascia over serratus anterior muscle on inferolateral border of pectoralis major muscle for silicone prosthesis breast reconstruction

作　　者：杨清默[1] 陈文霖[1] 陈双龙[1] 黄于凡[1] 梁婧[1] 杨巧鹭[1] 欧阳忠[1] YANG Qingmo;CHEN Wenlin;CHEN Shuanglong;HUANG Yufan;LIANG Jing;YANG Qiaolu;OUYANG Zhong(Department of Breast Surgery,the First Affiliated Hospital,Xiamen University,Xiamen,Fujian361003,China)

机构地区：[1]厦门大学附属第一医院乳腺外科,福建厦门361003

出　　处：《中国普通外科杂志》2018年第11期1452-1457,共6页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81672595)

摘　　要：目的:探讨胸大肌外下方前锯肌筋膜切口在硅凝胶假体乳房再造中的应用效果。方法:回顾2014年2月—2015年1月124例行乳腺切除加假体植入乳房再造的乳腺癌患者临床资料,其中传统的乳腺癌改良根治术23例,保留皮肤的全乳切除术22例,保留乳头乳晕的全乳切除术79例,患者均应用胸大肌外下方前锯肌筋膜切口行硅凝胶假体乳房再造。分析手术情况,术后效果,并发症及远期随访结果。结果:124例患者均成功完成手术,手术时间为65～120 min,平均(83.62±14.18)min;术中出血量为45～105 mL,平均(78.14±17.47)mL。术后外观评价"优良"率为82.25%(102/124)。术后血清肿7例,经引流后好转;切口愈合不佳,伤口裂开5例,经抗炎,换药,再次缝合后好转;无假体取出患者。随访22～50个月,失访9例,失访前均无瘤生存;骨转移5例,肺转移1例,肝转移1例,无局部复发患者。结论:胸大肌外下方前锯肌筋膜切口在硅凝胶假体乳房再造中安全有效,操作简便,适合推广。Objective:To assess the application efficacy of using incision of the fascia over the serratus anterior muscle on the inferolateral border of the pectoralis major muscle for silicone prosthesis breast reconstruction. Methods:The clinical data of124patients with breast cancer undergoing total mastectomy and prosthesis implantation for breast reconstruction from February2014to January2015were reviewed.Of the patients, 23cases underwent traditional modified radical mastectomy,22cases underwent skin sparing total mastectomy) and79cases underwent nipple sparing total mastectomy. All patients received breast reconstruction with silicone prosthesis though incision of fascia over the serratus anterior muscle on the inferolateral border ofpectoralis major muscle.The surgicalvariables,postoperative results, complications and long-term outcomes were analyzed.Results:Operation was successfully completed in all the124patients.The operative time was65-120min, with an average of(83.62±14.18)min,and the intraoperative blood loss was45-105mL,with an average of (78.14±17.47)mL.After operation,the excellent/good rate of the appearance evaluation for the reconstructed breast was82.25%(102/124).Seroma occurred in7patients,which was relieved after drainage;incision dehiscence was observed in5cases and was resolved by anti-inflammatory treatment,dressing change and resuture;prosthesis removal was required in none of the patients.Followed-up was performed for22to 50months,and9patients were lost to follow-up,all of whom had disease free survival before lost to follow-up. During follow-up,5patients developed bone metastases,pulmonary metastases and liver metastases occurred in one case each,and no local recurrence was found in any of them. Conclusion:Using incision of the fascia over the serratus anterior muscle on the inferolateral border of the pectoralis major muscle for silicone prosthesis breast reconstruction is safe,effective and easy to be performed, and is recommended to be widely adopted.

关 键 词：乳腺肿瘤 乳房切除术 乳房成形术 假体植入 

分 类 号：R737.9[医药卫生—肿瘤]