V-Y背阔肌肌皮瓣修复局部晚期乳腺癌术后胸壁缺损14例  

V-Y latissimus dorsi musculocutaneous flap for reconstruction of chest wall defects after local advanced breast cancer surgery:Report of 14 cases

作　　者：董苑[1] 李姝墨 陈亮[1] 葛菲 周厅 冒青[1] 孙哲[1] 陈诚[1] 李飞丽 DONG Yuan;LI Shumo;CHEN Liang;GE Fei;ZHOU Ting;MAO Qing;SUN Zhe;CHEN Cheng;LI Feili(Department of Breast Surgery,The First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of General Surgery,Long Chuan County People's Hospital,Dehong,Yunnan Province 678700,China)

机构地区：[1]昆明医科大学第一附属医院乳腺外科,昆明650032 [2]云南省陇川县人民医院普通外科,云南德宏678700

出　　处：《中华显微外科杂志》2022年第6期634-638,共5页Chinese Journal of Microsurgery

基　　金：云南省教育厅科学研究基金项目(K13219176)。

摘　　要：目的探讨V-Y背阔肌肌皮瓣在局部晚期乳腺癌(LABC)术后胸壁缺损修复中的临床效果。方法2018年9月-2021年2月,对昆明医科大学第一附属医院乳腺外科收治的14例LABC患者行根治性切除后造成的胸壁巨大缺损,用V-Y背阔肌肌皮瓣进行修复,胸壁缺损的大小为15.0 cm×22.0 cm~22.0 cm×35.0 cm,V-Y背阔肌肌皮瓣的大小为12.0 cm×28.0 cm~18.0 cm×35.0 cm,肌瓣体积12.0 cm×28.0 cm×2.0 cm~18.0 cm×35.0 cm×3.5 cm。术后通过门诊、电话随访。结果14例皮瓣全部成活,3例"Y"形交点处有1.0~3.0 cm范围皮肤缺血坏死,均无背部血清肿,伤口均一期愈合。手术时间平均6.3 h。术后随访4~41个月,中位随访18个月,皮瓣色泽、质地、弹性良好,无明显臃肿,外形良好,13例患侧上肢功能正常,无上肢淋巴水肿,1例患者术后3年出现患侧上肢淋巴水肿。11例患者术后行放射治疗,皮瓣放疗耐受性好。14例均无胸壁局部复发,5例出现远处转移,3例患者因远处转移死亡。结论用V-Y背阔肌肌皮瓣对LABC术后胸壁缺损进行修复是简单、可靠、有效的方法。Objective To demonstrate the clinical effect of latissimus dorsi musculocutaneous flap with primary closure in V-Y suture in the repair of major lesions in the anterior chest wall that was left after mastectomies with locally advanced breast cancer(LABC)surgery.Methods From September 2018 to February 2021,the technique was employed on 14 female cancer patients who had LABC surgery in the Department of Breast Surgery of the First Affiliated Hospital of Kunming Medical University.The patients received radical mastectomies with major resection of cutaneous tegument.The defect areas in chest wall were 15.0 cm×15.0 cm-22.0 cm×35.0 cm.The sizes of flap were 12.0 cm×28.0 cm-18.0 cm×35.0 cm.The sizes of musculocutaneous flap were 12.0 cm×28.0 cm×2.0 cm~18.0 cm×35.0 cm×3.5 cm.All patients were entered the postoperative follow-up through out-patient clinic and telephone interviews.Results The flap provided an efficient coverage in closing the defects among all 14 patients.Three patients presented small areas(1.0-3.0 cm)of superficial necrosis in Y-cross area of the flap.None of the patient had back swelling.The average operation time was 6.3 hours.Postoperative follow-up varied from 4 to 41 months(18 months in average).The colour,texture,elasticity of the flaps were acceptable,with good shapes.Function of upper limbs was normal in 13 cases without lymphedema,except 1 who had lymphedema of affected limb at 3 years after surgery.Eleven cases had radiotherapy after surgery with good tolerance.None of the cases had local recurrence of breast cancer.Five cases had metastasis,3 cases died of metastasis.Conclusion The latissimus dorsi musculocutaneous flap with primary closure in V-Y suture is easy to perform and an reliable and efficient technique in repairing large defects in the anterior chest wall left after a LABC surgery.

关 键 词：背阔肌肌皮瓣 乳腺癌 晚期 胸壁缺损 修复 显微外科技术 

分 类 号：R737.9[医药卫生—肿瘤]