基于单中心的局部巨大乳腺癌手术切除后胸壁重建及巨大创面修复策略  

Optimization strategies for thoracic wall reconstruction and repairing the huge soft-tissue defects after locally advanced breast cancer resection based on 11 years clinical experiences in a single Chinese center

作　　者：朱明 马晓飞 杨燕文 张勇 冯自豪 亓发芝 顾建英 ZHU Ming;MA Xiao-fe;YANG Yan-wen;ZHANG Yong;FENG Zi-hao;QI Fa-zhi;GU Jian-ying(Department of Orthopaedics,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Yuyan Plastic Clinic,Beijing 100000,China)

机构地区：[1]复旦大学附属中山医院整形外科,上海200032 [2]御颜医疗美容诊所,北京100000

出　　处：《中国临床医学》2018年第2期182-187,共6页Chinese Journal of Clinical Medicine

摘　　要：目的:基于单中心11年的临床实践探讨局部巨大乳腺癌(locally advanced breast cancer,LABC)手术切除后胸壁重建及巨大创面修复策略。方法:回顾性分析2006年3月至2017年8月收治的252例LABC患者的临床资料,其中197例为原发肿瘤,55例为复发肿瘤。所有患者术前均接受新辅助化疗。入院后完善相关术前检查后行乳腺肿块切除手术及术后创面修复重建,观察手术相关指标及患者术后远期预后,总结临床诊疗经验。结果:患者均为女性,年龄38~67岁,平均(47.5±9.2)岁,均为单侧,左侧肿物137例(54.4%),右侧肿物115例(45.6%)。所有患者乳腺肿瘤均顺利切除,住院时间9~45d,平均(12.9±3.4)d,术后随访5~72个月,平均(18.7±9.6)个月。平均手术时长(3.8±1.7)h,术中平均出血(348.4±106.6)mL。肿物面积最大为30cm×25cm,最小为5cm×13cm,合并胸骨或肋骨缺损71例(28.2%),其中30例无需钛网修复,41例应用个性化钛网重建胸壁。修复软组织缺损的皮瓣面积为14cm×6cm^29cm×30cm,应用带蒂背阔肌肌皮瓣98例(38.9%),腹直肌肌皮瓣56例(22.2%),侧胸壁皮瓣34例(13.5%),胸大肌肌皮瓣及乳房瓣31例(12.3%),游离腹壁下动脉穿支(DIEP)皮瓣17例(6.7%),局部皮瓣16例(6.3%)。所有病例均恢复良好,皮瓣外形及功能恢复满意,患者生活质量明显改善(P<0.05)。结论:LABC患者的治疗需要多学科的协作,术前新辅助化疗的应用、术中适当扩大肿瘤切除范围、多种途径重建胸壁及修复术后巨大创面可提升患者的生存质量,改善患者预后。Objective:To review and summarize our experience of surgical approach and reconstructive strategy for locally advanced breast cancer(LABC).Methods:A retrospective study was conducted using the medical records of 252 patients who underwent LABC treatment in our department from March 2006 to August 2017.Totally 197 of them were primary tumor and 55 were secondary.All the patients were received neoadjuvant chemotherapy.Surgical technology and clinical outcomes were compared and statistical analyzed.Results:The average hospital stay time of these patients was(12.9±3.4)d(9-45 d),and the follow-up period after surgery was(18.7±9.6)months(5-72 months).The size of tumor ranged 30 cm×25 cm to 5 cm×13 cm.71 of these cases had the whole chest wall defect,which 41 of them reconstructed with titanium mesh to establish the stability of chest.The sizes of flaps for reconstructing soft tissue defects ranged 14 cm×6 cm-29 cm×30 cm.Different flaps were selected for covering the chest wall defect,which local flaps for 16 case(6.3%);pectoralis major myocutaneous combined with breast flaps for 31 cases(12.3%);lateral thoracic flaps for 34 cases(13.5%);latissimus dorsi myocutaneous flaps with pedicle for 98 cases(38.9%);rectus abdominis musculocutaneous flaps for 56 cases(22.2%)and deep inferior epigastric perforator flaps(DIEP flaps)for 17 cases(6.7%).All the patients recovered well,and the function and appearance of chest wall were satisfactory(P<0.05).Conclusions:Plastic technology for reconstruction provides a useful strategy and method for LABC treatment,and is able to improve the life quality and prognosis of the patients.

关 键 词：局部巨大乳腺癌 手术治疗 胸壁缺损 胸壁重建 

分 类 号：R62[医药卫生—整形外科]