倒T形切口缩乳术在乳房肥大或合并乳腺癌患者中的应用  

Inverted-T pattern breast reduction in breast hypertrophy patients with or without breast cancer

作　　者：韩晶[1] 全红 刘君君 严伟国 丁涵之 王璨 Tatsiana Paliyenka Han Jing;Quan Hong;Liu Junjun;Yan Weiguo;Ding Hanzhi;Wang Can;Paliyenka Tatsiana(Department of Breast Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120, China)

机构地区：[1]同济大学医学院附属东方医院乳腺外科,上海200120

出　　处：《中华乳腺病杂志（电子版）》2019年第2期75-80,共6页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的探讨倒T形切口缩乳术在乳房肥大患者,特别是合并乳腺癌的患者手术中的应用及其临床意义。方法本回顾性研究共纳入2007年10月到2017年10月分别在同济大学附属东方医院及附属同济医院乳腺外科行缩乳术的39例乳房肥大女性患者,均采用倒T形切口(内侧蒂25例,垂直蒂5例,外侧蒂9例)。其中,包括18例符合保留乳房手术指征的乳腺癌患者(内侧蒂10例,垂直蒂4例,外侧蒂4例)。术后6、12个月评价美容效果(乳腺癌患者待放射治疗结束后进行评价)。评估患者的术后并发症、满意度以及复发转移情况。结果 39例患者术后乳房外形自然、对称,明显缩小上提,乳头、乳晕血供和感觉良好,瘢痕不明显,患者满意度高。1例术后2周出现一侧乳房的乳头乳晕区坏死,经过清创换药后愈合。5例术后双侧乳头乳晕感觉减退,其中4例在术后6个月左右恢复正常感觉,1例在术后12个月恢复。5例出现术后局部乳房组织硬结,其中3例为接受过放射治疗的乳腺癌患者,二次手术切除硬结后无再次发生。3例出现瘢痕处猫耳畸形,再次局部麻醉手术修整后效果良好,3例瘢痕增粗,其余患者瘢痕正常。乳腺癌患者中有3例出现放射治疗后患侧乳房皮肤水肿,术后12个月消退。术后6个月进行了美容效果评价,极好25例,良好10例,中等4例,差0例(18例乳腺癌患者中,极好9例,良好6例,中等3例,差0例)。术后12个月的美容效果评价显示:极好25例,良好13例,中等1例,差0例(18例乳腺癌患者中,极好9例,良好8例,中等1例,差0例)。随访时间最长的1例患者(双侧乳房单纯性重度肥大)术后观察了10年,乳房外形无明显变化。全部患者术后随访15～120个月,中位随访61个月,18例乳腺癌患者均无局部复发转移。结论对于乳房肥大,特别是合并乳腺癌的患者,采用倒T形切口缩乳术,既可切除病变,又可缩小并悬吊乳房。Objective To explore the application and clinical significance of the inverted-T pattern breast reduction in patients with breast hypertrophy, especially associated with breast cancer. Methods This retrospective study enrolled 39 patients with breast hypertrophy in Tongji Hospital and East Hospital Affiliated to Tongji University from October 2007 to October 2017. Those patients underwent inverted-T pattern breast reduction, including medial pedicle used in 25 patients, vertical pedicle in 5 and lateral pedicle in 9. Among 39 patients, there were 18 breast cancer patients, with the indication of breast conserving surgery, so they underwent both breast conserving surgery and inverted-T pattern breast reduction, in which medial pedicle was used in 10 patients, vertical pedicle in 4 and lateral pedicle in 4. The aesthetic effect was evaluated in 6 and 12 months after operation except 18 breast cancer patients who were evaluated after radiotherapy. The postoperative complications, recurrence, metastasis and patient satisfaction were observed. Results All 39 patients were satisfied with natural and symmetrical postoperative appearance, obvious reduction and lifting of the breasts, normal blood supply and sensation of the nipple-areola area, and no obvious scar. One patient had necrosis of the nipple-areola area in one breast two weeks after operation, which healed after debridement and dressing change. Postoperative sensation decrease of bilateral nipple-areola areas occurred in five patients and it returned to normal after 6 months in four patients, 12 months in one patient. Postoperative local breast tissue induration was observed in five patients, including three breast cancer patients who received radiotherapy and presented no recurrence after removing the indurated lesions. Dog-ear deformity appeared in the surgical scar of three patients, and it was repaired by surgery under local anesthesia. Another three patients had slightly thickened scars, while the rest had normal scars. Three breast cancer patients develo

关 键 词：乳腺肿瘤 乳房成形术 保留乳房手术 乳房肥大 

分 类 号：R737.9[医药卫生—肿瘤]