自体肋软骨支架乳头再造在乳房假体重建手术中的应用体会  

Nipple reconstruction with autogenous rib cartilage scaffold in breast reconstruction with implant

作　　者：崔军威[1] 刘晓岭[1] 杨子健 胡艺冰 高睿 李锋 韦伟[1] 何劲松 Cui Junwei;Liu Xiaoling;Yang Zijian;Hu Yibin;Gao Rui;Li Feng;Wei Wei;He Jinsong(Department of Breast Surgery,Shenzhen Hospital of Peking University,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院乳腺外科,518036

出　　处：《中华乳腺病杂志（电子版）》2021年第4期201-205,共5页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：广东省深圳市三名工程资助项目(SZSM201612010)。

摘　　要：目的探讨自体肋软骨支架乳头再造术在乳房重建手术中的临床应用价值。方法选取2017年6月至2019年6月北京大学深圳医院乳腺外科收治的21例乳腺癌和乳头受侵犯的叶状肿瘤患者,均接受硅胶假体乳房重建术+自体肋软骨支架乳头再造术。记录患者手术时间、出血量、住院时间、疼痛情况、再造乳头成活情况、术后并发症和患者满意度。结果21例硅胶假体乳房重建术+自体肋软骨支架乳头再造术均成功。乳头再造手术时间为(58.3±7.4)min,范围:40.0~71.0 min;手术总出血量为(14.7±3.1)ml,范围:10.0~20.0 ml,患者术后疼痛评分为(2.5±0.5)分,范围:2.0~3.0分,为轻度疼痛不适。手术后住院时间为(4.1±1.3)d,范围:3.0~7.0 d。2例患者术后出现乳头皮瓣部分坏死,后期经过换药后皮瓣恢复血供。所有患者随访6~24个月,中位随访13个月。患者对再造乳头均较为满意,其中非常满意19例,良好2例,尚可0例,差0例。结论对于不能保留乳头的乳房重建手术患者而言,自体肋软骨支架乳头再造手术有创伤小、恢复期短、技术易掌握等优势,具有较好的临床推广应用价值。Objective To explore the application of nipple reconstruction using rib cartilage scaffold in breast reconstruction with implant.Methods The study reviewed 20 cases of breast cancer and one case of phyllodes tumor(involving nipple and areola)in the Department of Breast Surgery,Shenzhen Hospital of Peking University from June 2017 to June 2019.They all underwent nipple reconstruction using rib cartilage scaffold and breast reconstruction with silicone implant.Operation time,blood loss,length of hospital stay,pain,survival of reconstructed nipples,postoperative complications and patient satisfaction were recorded.Results The surgery was successful in all cases.Operation time was(58.3±7.4)min(range:40.0-71.0 min);postoperative blood loss was(14.7±3.1)ml(range:10.0-20.0 ml);scores of postoperative pain was 2.5±0.5(range:2.0-3.0),indicating mild pain and discomfort.The length of postoperative hospital stay was(4.1±1.3)d(range:3.0-7.0 d).Two patients had partial necrosis of papillary flaps,and blood supply of flaps were restored after dressing change.All patients were followed up for 6-24 months,median 13 months.All patients were satisfied with the reconstructed nipples,including 19 patients with excellently-reconstructed nipples,2 with well-reconstructed nipples and none with poorly-reconstructed nipples.Conclusion For patients who cannot spare nipples in breast reconstruction,nipple reconstruction using rib cartilage scaffold has the advantages of less trauma,short recovery period,and less-demanding in techniques,worthy of clinical application.

关 键 词：肋软骨 乳头再造 乳腺肿瘤 乳房成形术 

分 类 号：R737.9[医药卫生—肿瘤] R622.9[医药卫生—临床医学]