乳腺象限或大区段切除术中应用侧胸壁脂肪筋膜瓣乳房成形的研究  

Mammaplasty with lateral thoracic steato-fascia flap in segmental or quadrant mastectomy

作　　者：洪士开[1] 王圣应[1] 郑绪才[1] 陈公仆 刘松[1] 高红[1] 赵源源[1] 

机构地区：[1]安徽省肿瘤医院乳腺外科,合肥230088

出　　处：《中华乳腺病杂志（电子版）》2016年第4期220-225,共6页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的探讨乳腺象限或大区段切除术中应用侧胸壁脂肪筋膜瓣即刻乳房成形的疗效及可行性。方法回顾性分析2014年2月至2015年11月安徽省肿瘤医院乳腺外科收治的96例行乳腺象限或大区段切除术的乳腺良性疾病患者临床资料，其中43例术中即刻应用侧胸壁脂肪筋膜瓣修复乳房外形（乳房成形组），37例未行侧胸壁脂肪筋膜瓣乳房成形（非乳房成形组），16例行皮下腺体切除术即刻假体植入重建乳房（假体重建组）。比较3组患者的手术相关特征、并发症及美容效果。偏态分布的数据用M（P2.5-P75）表示，组间比较采用多个独立样本的非参数检验（Kruskal-Wallis检验），组间多重比较采用Nemenyi检验。结果乳房成形组患者手术时间比假体重建组短[70．0（60．0～80．0）min比96．0（90．5—101．5）min，x^2=-4．338，P〈0．017]。并且，乳房成形组患者的住院时间与非乳房成形组相似[11．0（10．0—14．0）d比11．0（9．5～12．0）d，x^2=1．080，P〉0．017]。乳房成形组患者术后住院时间明显比假体重建组短[8．0（7．0～10．0）d比10．0（8．3—11．0）d，x^2=2．644，P〈0．017]，其引流管留置时间也无明显增加（x^2=3．176，P=0．204）。术后随访3—24个月（中位随访13个月），乳房成形组、非乳房成形组、假体重建组各感染5、3、0例，差异无统计学意义（x^2=1．640，P=0．486）。乳腺成形组患者术后总体满意度评分为9．2（9．0～9．5）分，优于非乳房成形组的8．5（7．3～8．7）分（x^2=7．388，P〈0．017）。结论对于需要行乳腺象限或大区段切除术的乳腺良性疾病患者，术中应用侧胸壁脂肪筋膜瓣修复乳房外形具有技术可行、美容效果好的优点，宜于临床推广应用。Objective To investigate therapeutic effect and feasibility of immediate mammaplasty with lateral thoracic steato-fascia flap in segmental or quadrant mastectomy. Methods We retrospectively studied clinicopathologic data of 96 patients with benign diseases who underwent segmental or quadrant mastectomy in Department of Breast Surgery, Anhui Provincial Cancer Hospital from February 2014 to November 2015, including 43 patients who received segmental or quadrant mastectomy and immediate mammaplasty with lateral thoracic steato-fascia flap （mammaplasty group ） and 37 patients who received segmental or quadrant mastectomy without breast mammaplasty （non-mammaplasty group） and 16 patients had subcutaneous mastectomy and immediate breast reconstruction with prosthesis implantation （breast reconstruction group）. The clinical characteristics, complications and cosmetic effects were compared among 3 groups. The data with skewed distribution were expressed as M （P25-P75 ）. The multiple independent samples were analyzed by Kruskal-Wallis test. Nemenyi test was used for multiple comparisons between groups. Results The operation time in mammaplasty group was 70.0 （60.0-80.0） min, less than 96.0 （90.5-101.5） min in breast reconstruction group （ x^2=-4. 338, P〈0. 017）. The hospitalization stay was not significantly different between mammaplasty group and non-mammaplasty group [ 11.0 （ 10. 0-14. 0 ） d vs 11.0 （ 9. 5-12. 0 ） d, x^2 = 1. 080, P〉0. 017 ]. The postoperative hospitalization stay in breast reconstruction group was 10. 0 （8. 3-11.0） d, significantly longer than 8. 0 （ 7.0 - 10.0 ） d in breast mammaplasty group （ x^2 = 2. 644, P 〈 0. 017 ）. The drainage time was not significantly different among three groups （ x^2 = 3. 176, P = 0. 204 ）. All patients were followed up for 3-24 months （median 13 months）. Five patients had infection in mammaplasty group, 3 in non-mammaplasty group, 0 in breast reconstruction group, respectively, indicating no significant differen

关 键 词：乳房 乳腺肿瘤 乳房成形术 脂肪类 筋膜 

分 类 号：R737.9[医药卫生—肿瘤] R655.8[医药卫生—临床医学]