乳腺癌胸壁复发聚丙烯单丝纤维补片联合背阔肌皮瓣胸壁重建  

Reconstruction of Chest Wall with Monofilaments Meshes and Using the Latissimus Dorsi Flap in Dealing with Postoperative Recurrence of Breast Cancer:7 Cases Report

作　　者：刘宝胤[1] 骆成玉[1] 陈忠存[2] 陈溯 

机构地区：[1]首都医科大学附属复兴医院普外科,北京100038 [2]首都医科大学附属复兴医院整形外科,北京100038 [3]首都医科大学附属复兴医院胸外科,北京100038

出　　处：《中国现代手术学杂志》2017年第5期350-353,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨乳腺癌胸壁复发病灶切除同时应用聚丙烯单丝纤维补片联合背阔肌皮瓣进行胸壁再造的可行性。方法 2010年2月~2016年1月我科收治7例乳腺癌胸壁复发患者,均为女性,平均年龄46.6(38~62)岁,病程8~26个月。术中切除复发病灶后,胸壁皮肤软组织缺损范围达(14 cm×11 cm)^(18 cm×13 cm),采用三层聚丙烯单丝纤维补片修补,带蒂背阔肌肌皮瓣移位覆盖创面,皮瓣大小(14 cm×6.5 cm)^(18 cm×6 cm);背部皮肤直接缝合。结果 7例即时胸壁再造均获成功,皮瓣均顺利成活。术后1例供区血清肿,经数次穿刺抽液加压包扎后痊愈;1例皮瓣远端发生坏死,面积约1.5 cm×1.5 cm,经换药后延期愈合。本组患者均获随访,随访时间平均23.5(12~33)个月。术后远处转移1例,无局部复发和死亡病例。术后皮瓣外观良好,蒂部无臃肿,肩关节活动无明显受限。结论乳腺癌胸壁复发后病灶切除同时应用聚丙烯单丝纤维补片联合背阔肌皮瓣进行胸壁再造具有重要的临床价值。Objective To investigate the clinical feasibility of chest wall reconstruction with monofilaments meshes and the latissimus dorsi flap graft in dealing with breast cancer recurrence after tumor resection. Methods A retrospective analysis was made on the clinical data from 7 cases of breast cancer recurrence treated by tumor resection and chest well reconstruction between February 2010 and January2016. There were 7 females with an average age of 46. 6 years（range,38 to 62 years）; The median disease duration was 14. 3 months（range,8 to 26 months）. The skin defect area of chest wall was 14 cm ×11 cm to 18 cm × 13 cm after tumor resection. The monofilament meshes and the latissimus dorsi flap were designed to repair the defect wounds. The flap of latissimus dorsi based on the thoracodorsal artery with a size of 14 cm × 6. 5 cm to 18 cm × 6 cm. All the donor site was sutured directly. Results All 7 cases were successful in the surgery with grafting flap survival. Among them,2 cases appeared delayed healing because of distal necrosis in one flap and seroma of donor site in one flap. All cases were followed up for 12 months to 33 months. No local recurrence and death occurred,but distant metastasis in 1 case. The appearance of flap was satisfied and joint motion was well. Conclusion The application of monofilaments meshes and latissimus dorsi flap has important clinical value to repair the chest wall defect after tumor resection in breast cancer recurrence.

关 键 词：胸壁缺损 胸壁重建 乳腺肿瘤 肿瘤复发 局部 再手术 

分 类 号：R737.9[医药卫生—肿瘤]