带蒂胸外侧动脉穿支皮瓣在保乳术后即刻乳房重建中的临床应用  

Clinical application of the pedicled lateral thoracic artery perforation flap in breast reconstruction immediately after breast-conserving surgery

作　　者：张小丽[1] 李赞[2] 宋达疆[2] 王业成 海涛[1] ZHANG Xiaoli;LI Zan;SONG Dajiang;WANG Yecheng;HAI Tao(Thyroid and Breast Disease Diagnosis and Treatment Center,Department of General Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Oncology Plastic Surgery,Hunan Province Cancer Hospital,Changsha 410008,China)

机构地区：[1]首都医科大学宣武医院普外科甲乳中心,北京市100053 [2]湖南省肿瘤医院肿瘤整形外科,湖南省长沙市410008

出　　处：《组织工程与重建外科》2022年第5期382-385,共4页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的探讨带蒂胸外侧动脉穿支皮瓣在乳腺癌保乳术后一期乳房重建中的应用效果及其肿瘤安全性。方法纳入2020年10月至2022年5月收治的41例以胸外侧动脉穿支皮瓣行保乳整形的乳腺癌患者,年龄35~82岁,平均56.4岁,均为女性。肿瘤均为单侧,左侧15例,右侧26例;肿瘤位于外上象限21例,外下象限6例,内上象限9例,内下象限3例,乳头后方2例;肿瘤直径0.9~4.0 cm;luminal A型14例,luminal B型17例,HER2过表达型7例,三阴型3例;Ⅰ期肿瘤19例,Ⅱ期肿瘤16例,Ⅲ期肿瘤6例。术后短期观察皮瓣成活情况及重建后的乳房外形。所有患者均行肿瘤综合治疗,随访原发病灶局部复发情况。结果41例患者切除肿瘤及乳腺组织质量平均约40 g。术后随访3~24个月,平均12个月。所有皮瓣均成活。放疗后皮瓣体积无缩小,重建乳房外形满意。所有患者均未出现乳腺癌局部复发。结论带蒂胸外侧动脉穿支皮瓣是操作相对简单、可重复性强的肿瘤整形技术,可极大改善保乳后乳房外形,值得临床推广应用。Objective To investigate the clinical application effect of the pedicled lateral thoracic artery perforator flap in breast reconstruction after breast conserving surgery and its tumor safety.Methods A total of 41 breast cancer patients who underwent breast-conserving surgery using pedicled lateral thoracic artery perforator flap from October 2020 to May 2022 were included in the study.Age ranged from 35 to 82 years old,56.4 years on average.All the paitents were females.The tumors were all unilateral,with 15 cases on the left and 26 cases on the right side.The locations of the masses were the out upper lateral quadrant(n=21),the outer lower quadrant(n=6),the inner upper quadrant(n=9),the inner lower quadrant(n=3),and the posterior nipple(n=2).The diameter ranged from 0.9 cm to 4.0 cm.There were luminal A type(n=14),luminal B type(n=17),HER2 overexpression type(n=7),and triple negative type(n=3);There were 19 cases in stageⅠ,16 cases in stageⅡ,and 6 cases in stageⅢ.Survival of the flap,the shape of the reconstructed breast and the local recurrence were observed after operation.Results The average mass of tumor and breast tissue resected was about 40 g.All flaps survived.There was no reduction in flap volume after radiotherapy.All 41 patients were followed up for 3 to 24 months(12 months on average)with satisfactory results.No recurrence of breast cancer happened.Conclusion The pedicled lateral thoracic artery perforator flap is a relatively simple and reproducible reconstructive technique,which greatly improves the breast shape after breast conserving,and is worthy of clinical application and promotion.

关 键 词：乳腺癌 保乳手术 胸外侧动脉穿支皮瓣 

分 类 号：R655.8[医药卫生—外科学] R622[医药卫生—临床医学]