带蒂大网膜瓣在乳腺癌术后乳房再造中的应用研究  

Application of pedicled omentum flap in breast reconstruction of breast cancer patients

作　　者：万能斌[1] 刘德权[2] 卢伶俐[1] 何潇[1] 宋达疆[3] 李赞[3] 周晓[3] 彭文[3] 柳泽洋 WAN Nengbin;LIU Dequan;LU Lingli;HE Xiao;SONG Dajiang;LI Zan;ZHOU Xiao;PENG Wen;LIU Zeyang(Department of Breast Surgery,Hunan Cancer Hospital,Changsha Hunan,410008,P.R. China;The First Department of Breast Surgery,Yunnan Province Cancer Hospital,the Third Affiliated Hospital of Kunming School of Medicine,Kunming Yunnan,650000,P.R.China;Department of Oncology Plastic Surgery,Hunan Cancer Hospital,Changsha Hunan,410008,P.R.China)

机构地区：[1]湖南省肿瘤医院乳腺外科,长沙410008 [2]昆明医科大学第三附属医院(云南省肿瘤医院)乳腺外一科,昆明650000 [3]湖南省肿瘤医院肿瘤整形外科,长沙410008

出　　处：《中国修复重建外科杂志》2019年第8期1006-1010,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：湖南省自然科学基金面上项目(2018JJ2241、2018JJ2242);湖南省自然科学基金科卫联合项目(2018JJ6028);湖南省肿瘤整形外科临床医学研究中心平台建设专项资助(2013TP4087)~~

摘　　要：目的探讨带蒂大网膜瓣在乳腺癌术后乳房再造中的临床应用。方法 2013年5月-2017年10月,对205例乳腺癌患者行改良根治术联合带蒂大网膜瓣移植再造乳房。患者均为女性;年龄26~58岁,平均34.9岁。左侧127例、右侧78例;肿瘤直径2~5 cm,平均2.9 cm。乳腺癌分期:Ⅰ期120例,Ⅱ期85例。病理诊断:浸润性导管癌126例,浸润性小叶癌79例。病程10~92 d,平均38.5 d。肿物切除后遗留缺损范围为9 cm×6 cm^18 cm×12 cm。带蒂大网膜瓣切取范围为18 cm×10 cm^22 cm×16 cm。结果根据术中观察的组织特点,将大网膜分为4种类型,稀薄型(42例,20.5%)、中间型(133例,64.9%)、肥厚型(24例,11.7%)、缺如型(6例,2.9%)。术后带蒂大网膜瓣均成活,切口Ⅰ期愈合。患者均获随访,随访时间6~74个月,平均24.5个月;其中83例随访达5年以上。再造乳房外形可、弹性好,无挛缩变形。供区仅遗留线性瘢痕,腹部功能无影响。随访期间无乳腺癌复发。结论带蒂大网膜瓣切取安全可靠、质地优良,是乳腺癌术后乳房再造的理想方法之一。Objective To explore the clinical application of the pedicled omentum flap in breast reconstruction of breast cancer patients. Methods Between May 2013 and October 2017, 205 patients with breast cancer received modified mastectomy. The pedicled omentum flap was used to reconstruct breast at the same time. All patients were female with an average age of 34.9 years(mean, 26-58 years). The tumor located at left breast in 127 cases and right side in78 cases. The diameter of the tumor was 2-5 cm(mean, 2.9 cm). The 120 cases of breast cancer were at stage Ⅰ and 85 cases were at stage Ⅱ;and 126 cases were invasive ductal carcinoma and 79 cases were invasive lobular carcinoma. The course of disease ranged from 10 to 92 days(mean, 38.5 days). The size of defect after tumor ablation ranged from 9 cm×6 cm to 18 cm×12 cm;the size of pedicled omentum flap ranged from 18 cm×10 cm to 22 cm×16 cm. Results According to the anatomical basis, the omentum was divided into 4 types, including thin type(42 cases, 20.5%), medium type(133 cases, 64.9%), hypertrophy type(24 cases, 11.7%), and absence type(6 cases, 2.9%). All omentum flaps survived successfully and the incisions healed by first intention. All patients were followed up 6-74 months(mean, 24.5 months);83 cases were followed up more than 5 years. The shape, texture, and elasticity of the reconstructed breast were good and no flap contracture deformation happened. Only linear scar left at the donor sites, and the function of abdomen was not affected. No local recurrence happened. Conclusion The pedicled omentum flap can be harvested safely and reliable, which is the one of ideal option for breast reconstruction in breast cancer patients.

关 键 词：乳腺癌 带蒂大网膜瓣 乳房再造 

分 类 号：R737.9[医药卫生—肿瘤]