带蒂背阔肌肌瓣在早期乳腺癌保乳术后乳房缺损修复研究中的应用  

Application of pedicled latissimus dorsi myocutaneous flap in the reconstruction of breast defect after breast conserving surgery for early breast cancer

作　　者：颜宁[1] 黄宇康[1] 陈腾腾[1] 方勤[1] 彭鸿彬 YAN Ning;HUANG Yu-kang;CHEN Teng-teng;FANG Qin;PENG Hong-bin(Department of Breast Surgery,Huizhou Central People's Hospital,Huizhou 516000,Guangdong,China)

机构地区：[1]惠州市中心人民医院乳腺外科,广东惠州516000

出　　处：《广东医学》2019年第9期1286-1290,共5页Guangdong Medical Journal

基　　金：惠州市科技计划(医疗卫生)项目(编号:2018Y038)

摘　　要：目的探讨带蒂背阔肌肌瓣修复早期乳腺癌保乳手术后胸壁皮肤软组织缺损的疗效和美容效果。方法回顾性分析收治的98例早期乳腺癌行保乳手术患者的临床资料,51例行保乳术后即时无瘢痕背阔肌乳房修复术(观察组),47例行保乳术后即时传统背阔肌乳房修复术(对照组),比较两组手术情况、术后并发症及预后情况。结果观察组手术时间、住院时间均短于对照组,差异有统计学意义(P <0. 05)。两组患者在切除乳腺体积、术中出血量、术后并发症的发生率方面均差异无统计学意义(P> 0. 05);随访时间为18～48个月,两组远处转移率、累积生存率、乳房美学等级优良率均差异无统计学意义(P> 0. 05),但观察组术后患者满意率高于对照组(90. 20%vs 68. 09%),且观察组术后胸背痛发生率低于对照组(19. 61%vs48. 94%),差异均有统计学意义(P <0. 05)。结论应用无瘢痕带蒂背阔肌肌瓣修复早期乳腺癌保乳术后缺损,能够有效达到无瘤目的,手术耗时短,住院时间短,且具有良好的乳房美容效果,能够避免供区瘢痕,降低术后肩背痛发生率,患者满意度高,应在临床加以推广。Objective To evaluate the clinical effect and aesthetic effect of pedicled latissimus dorsi myocutaneous flap in repairing the defect of skin and soft tissue on chest after breast-conserving surgery for early breast cancer.Methods The clinical data of 98 patients with early breast cancer who received breast-conserving surgery were retrospectively reviewed. Among them,51 patients received immediate breast reconstruction with scarless latissimus dorsi after breast conserving surgery( observation group),and 47 patients received immediate breast reconstruction with traditional latissimus dorsi after breast conserving surgery( control group). The operation situation,postoperative complications and prognosis were compared between the two groups. Results The operation time and hospital stay of the observation group were significantly shorter than those of the control group( P < 0. 05). There was no significant difference in resection volume,intraoperative blood loss,or incidence of postoperative complications between the two groups( P > 0. 05). The follow-up time was 18 to 48 months,and there was no significant difference in distant metastasis rate,cumulative survival rate or breast aesthetic excellent rate between the two groups( P > 0. 05). However,the postoperative satisfaction rate was significantly higher in the observation group( 90. 20%) than that of the control group( 68. 09%,P < 0. 05). The incidence of postoperative chest and back pain in the observation group( 19. 61%) was significantly lower than that of the control group( 48. 94%,P < 0. 05). Conclusion Pedicled scarless latissimus dorsi myocutaneous flap can be used to repair the defect of breast cancer after breast conserving surgery,which can effectively achieve the objective of non-tumor,with shorter operation time and shorter hospitalization. It also have great cosmetic effect and higher patient satisfaction.

关 键 词：带蒂背阔肌肌瓣 早期乳腺癌 乳房缺损修复 保乳手术 

分 类 号：R737.9[医药卫生—肿瘤] R628[医药卫生—临床医学]