应用改良乳房下皱襞脂肪筋膜真皮瓣即刻修补早期乳腺癌保留乳房术后局部缺损  

Immediate reconstruction using modified inframammary adipofascial dermal tissue flap to repair local defect after breast conserving surgery in early breast cancer patients

作　　者：姚成才[1] 黄传蔷[1] 蒋丽 严国标[1] 陈庞洲[1] 

机构地区：[1]南方医科大学附属南海医院乳腺外科,广东佛山528200 [2]浙江省东阳市妇幼保健院乳腺病诊疗中心,322100

出　　处：《中华乳腺病杂志（电子版）》2017年第2期78-82,共5页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：佛山市卫生和计生局医学科研课题(20170263)

摘　　要：目的探讨采用改良乳房下皱襞脂肪筋膜真皮瓣即刻修复早期乳腺癌保留乳房术后局部缺损的临床应用,并评估其手术效果。方法对2012年10月至2015年10月南方医科大学附属南海医院乳腺外科收治的27例肿瘤位于乳房下半象限的早期乳腺癌行保留乳房手术的患者,术后即刻采用改良乳房下皱襞脂肪筋膜真皮瓣修补局部缺损,所有患者术后半年内予以放射治疗。术后1个月,按放射治疗联合中心(JCRT)的标准评定美容效果。放射治疗后1个月,按Harris标准评定术后美容效果。结果 27例早期乳腺癌患者随访1~36个月,中位随访时间18个月,无一例复发及转移。术后1个月,乳房外形优良率100.0%(27/27),患者满意率为92.6%(25/27);放射治疗后1个月,乳房外形优良率77.8%(21/27),满意率为85.2%(23/27)。放射治疗后,6例出现明显的皮肤色素沉着,4例乳头乳晕歪斜,1例乳房质地变韧和3例乳房体积的缩小。结论采用改良乳房下皱襞脂肪筋膜真皮瓣即刻修补肿瘤位于下半象限的早期乳腺癌患者保留乳房术后局部缺损,手术效果确切,乳房美学效果好,值得推广。Objective To explore the application of modified inframammary adipofascial dermal tissue flap in repairing local defect after breast conserving surgery in early breast cancer patients and assess the outcome. Methods Totally 27 early breast cancer patients whose tumors were in the lower quadrants of the breast underwent breast conserving surgery in Department of Breast Surgery, Nanhai Hospital Affiliated to South Medical University from October 2012 to October 2015. Immediate reconstruction using a modified inframammary adipofascial dermal tissue flap was performed to repair local defects after operation. All patients received radiotherapy within 6 months after surgery. The cosmetic effect was evaluated according to the standard of Joint Center of Radiotherapy （JCRT） one month after surgery and Harris standard one month after radiotherapy, respectively. Results All 27 early breast cancer patients were followed up for 1- 36 months, median 18 months. None reported recurrence and metastasis. One month after operation, the rate of excellent or good breast appearance was 100. 0% （27/27） and the satisfaction rate was 92. 6% （25/27）. One month after radiotherapy, the rate of excellent or good breast appearance was 77.8% （21/27） and the satisfaction rate was 85.2% （23/27）. After radiotherapy, 6 cases showed obvious skin pigmentation, 4 cases had nipple- areola inclination, 1 case had toughening of breast texture and 3 cases had breast volume reduction.Condusion Immediate reconstruction using modified inframammary adipofascial dermal tissue flap can be applied to repair local defect after breast conserving surgery in early breast cancer patients with tumors in the lower quadrants of the breast, with advantages of definite outcome and favorable cosmetic effect, worthy of wide application.

关 键 词：乳腺肿瘤 乳房切除术 区段 外科皮瓣 筋膜 保留乳房手术 

分 类 号：R737.9[医药卫生—肿瘤] R622[医药卫生—临床医学]