两步法扩张器/假体为基础的乳房全切术后乳房重建——71例手术分析报告  

Two step tissue expander/implant based breast reconstruction after mastectomy——report of 71 cases

作　　者：刘晓岭[1] 杨子健 崔军威[1] 胡慧[1] 刘巧刿[1] 韦伟[1] LIU Xiao-ling;YANG Zi-jian;CUI Jun-wei;HU Hui;LIU Qiao-gui;WEI Wei(Department of Thyroid and Breast Surgery,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院甲乳外科,广东深圳518036

出　　处：《哈尔滨医科大学学报》2018年第3期259-263,共5页Journal of Harbin Medical University

基　　金：深圳市三名工程中山大学孙逸仙纪念医院乳腺肿瘤医学部宋尔卫教授专家团队项目(SZSM201612010)

摘　　要：目的探讨乳房全切术后利用胸锁筋膜行两步法扩张器/假体为基础的即刻乳房重建手术治疗效果。方法需行乳房全切除手术的患者行一期扩张期植入,二期更换假体手术。乳房切除手术方法根据乳头乳晕复合体是否受侵犯,分为保留皮肤的皮下腺体切除术(skin sparing mastectomy,SSM)及保留乳头乳晕的皮下腺体切除术(nipple-sparing mastectomy,NSM)两种方法。乳房切除术后一期放置扩张器,术后辅助治疗(包括化疗、放疗、内分泌治疗、靶向治疗等)按照术后病理结果规范进行,术后进行扩张器的定期注水、随访,待术后辅助治疗(化疗、放疗)结束后,再行扩张器取出+假体植入手术。分析患者相关因素(如年龄、乳房容量、BMI)、疾病相关因素(如病理诊断、TNM分期、分子分型等)及手术操作相关并发症(如感染、包膜挛缩、皮肤皱褶等)与美容效果的关系。结果 71例需行乳房全切的患者入组,病理结果 12例为原位癌,2例反复复发的叶状肿瘤,57例为浸润性癌。一期扩张器植入手术,术后扩张器注水并随访过程中,发生3例(4. 3%)术后出现术区脓肿形成,导致扩张器取出; 1例(1. 4%)因随诊过程中肿瘤进展,暂停二期手术; 6例(8. 4%)因皮瓣扩张欠佳取出扩张器或中转为自体组织乳房重建。23例两侧乳房对称性欠佳(32. 8%)。NSM术后两侧乳头乳晕不在同一水平线。乳房容量及BMI为影响术后美容效果满意度的主要因素。结论乳房全切术后扩张器/假体为基础的乳房重建手术创伤小,治疗费用不高,操作简单易行。BMI小于25,乳房容量中等以下患者应用此手术可达到较好的美容效果。Objective To evaluate the effect of immediate two step tissue expander/implant based breast reconstruction using autologous clavi-pectoral fascia after mastectomy. Methods Patients needed to undertake skin sparing mastectomy （SSM） or nipple-sparing mastectomy （NSM） were evaluated by preoperative imaging to determine whether nipple-areola complex could be conserved. Tissue expander was placed after mastectomy. Adjuvant therapies （including chemotherapy, radiotherapy, etc） were conducted according to guidelines. Tissue expand ers were regularly expanded and followed up. Patients and disease related tactors were analyzed according to cosmetic results. Results Seventy-one patients were recruited among them, 12 cases were diagnosed as carcinoma in situ, 2 cases as recurrent borderline and malignant phyllode tumor, 57 cases were invasive ductal carcinoma. During the steady injection to the expender and follow-up after the first stage tissue expander implantation, infection happened on 3 cases （4. 3% ） with abscess and resulted failure. One patient （1.4%） quited due to cancer metastasis. Six patients （8.4%） changed to combined reconstruction using transverse abdominal muscle and implant due to unsatisfied skin expansion. Twenty-three （32. 8% ） complained about symmetrical unbalance. Patients underwent NSM and reconstruction had slightly elevated NAC compared with contralateral breast. Breast volume and body mass index （BMI） affeted cosmetic results. Conclusion Two step tissue expander/implant based breast reconstruction using autologous clavi-pectoral fascia has a good cosmetic result with minimal traumor and less medical cost. Patients, BMI below 25, with small to medial breast volume chould be selected with better cosmetic results.

关 键 词：乳房切除 乳房重建 手术并发症 

分 类 号：R655.8[医药卫生—外科学]