优化设计分叶背阔肌皮瓣修复局部晚期乳腺癌术后胸壁缺损  

Application of modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer patients

作　　者：王蕾[1] 宋达疆[2] 宋爱莉[1] 李赞[2] 周波[2] 吕春柳[2] 唐园园 WANG Lei;SONG Dajiang;SONG Aili;LI Zan;ZHOU Bo;Lü Chunliu;TANG Yuanyuan(Department of Breast and Thyroid Surgery,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan Shandong,250014,P.R.China;Department of Oncology Plastic Surgery,Hunan Province Cancer Hospital,Changsha Hunan,410008,P.R.China)

机构地区：[1]山东中医药大学附属医院乳腺甲状腺外科,济南250014 [2]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》2021年第9期1172-1176,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：湖南省肿瘤整形外科临床医学研究中心平台建设专项(2013TP4087);湖南省科卫联合项目(2018JJ6028);湖南省卫生健康委员会课题(B2019092);长沙市科技计划基础研究项目(kq1901074、kq1901077)。

摘　　要：目的探讨优化设计分叶背阔肌皮瓣修复局部晚期乳腺癌术后胸壁缺损的效果。方法2016年1月—2019年6月,收治64例单侧局部晚期乳腺癌女性患者。患者年龄34~50岁,平均41.3岁。病程6~32个月,平均12.3个月。原发肿瘤直径4.8~14.2 cm,平均8.59 cm。首先行乳腺癌改良根治术/根治术,遗留胸壁皮肤软组织缺损范围为16 cm×15 cm~20 cm×20 cm;采用顺行法(34例)或逆行法(30例)设计并切取分叶背阔肌皮瓣移植修复缺损,皮岛切取范围为13 cm×5 cm~17 cm×6 cm;皮瓣供区均直接闭合。结果术后2例(5.8%,2/34)顺行皮瓣、6例(20%,6/30)逆行皮瓣出现部分坏死,5例(16.7%,5/30)逆行皮瓣供区切口皮缘部分坏死,坏死皮瓣及供区皮缘经换药后均延期愈合;其余皮瓣均顺利成活,供区切口均Ⅰ期愈合。顺行及逆行皮瓣组间皮瓣部分坏死发生率差异无统计学意义(χ^(2)=2.904,P=0.091),供区延期愈合率差异有统计学意义(P=0.013)。患者术后均获随访,随访时间15~30个月,平均23.1个月。皮瓣外观、质地均满意;供区仅遗留线性瘢痕,肩关节活动无影响。所有患者肿瘤均未见局部复发;4例发生远处转移后死亡,生存时间20~28个月,平均22.6个月。结论优化设计分叶背阔肌皮瓣可修复局部晚期乳腺癌术后胸壁缺损,其中顺行法设计可以最大程度确保皮瓣血运,减少供区张力,降低术后并发症发生率。Objective To explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer(LABC)patients.Methods Between January 2016 and June 2019,64 unilateral LABC patients were admitted.All patients were female with an average age of 41.3 years(range,34-50 years).The disease duration ranged from 6 to 32 months(mean,12.3 months).The diameter of primary tumor ranged from 4.8 to 14.2 cm(mean,8.59 cm).The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy.All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps,including 34 cases with antegrade method and 30 cases with retrograde method.The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm.All the donor sites were closed directly.Results In antegrade group,2 flaps(5.8%,2/34)showed partial necrosis;in retrograde group,6 flaps(20%,6/30)showed partial necrosis,5 donor sites(16.7%,5/30)showed partial necrosis;and all of them healed after dressing treatment.The other flaps survived successfully and incisions in donor sites healed by first intention.There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups(χ^(2)=2.904,P=0.091).The difference in delayed healing rate of donor site between the two groups was significant(P=0.013).The patients were followed up 15-30 months,with an average of 23.1 months.The appearance and texture of the flaps were satisfactory,and only linear scar left in the donor site.No local recurrence was found in all patients.Four patients died of distant metastasis,including 2 cases of liver metastasis,1 case of brain metastasis,and 1 case of lung metastasis.The average survival time was 22.6 months(range,20-28 months).Conclusion The modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery.Antegrade design of the flap can ensure the blood supply

关 键 词：局部晚期乳腺癌 背阔肌皮瓣 分叶皮瓣 胸壁重建 

分 类 号：R737.9[医药卫生—肿瘤]