乳腺癌根治术后胸部放射性溃疡的修复策略及其临床效果  

Repair strategy of chest radiation ulcer after radical mastectomy for breast cancer and its clinical effect

作　　者：杜伟力 沈余明 程琳 代强 车可心 Du Weili;Shen Yuming;Cheng Lin;Dai Qiang;Che Kexin(Department of Burns,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院烧伤科,北京100035

出　　处：《中华烧伤与创面修复杂志》2024年第6期521-528,共8页Chinese Journal of Burns And Wounds

基　　金：国家重点研发计划(2018YFA0703104);北京市属医院科研培育计划(PX2024016);北京积水潭医院学科骨干(XKGG202209)。

摘　　要：目的探讨乳腺癌根治术后胸部放射性溃疡的修复策略及其临床效果。方法该研究为回顾性观察性研究。2020年9月-2023年9月,首都医科大学附属北京积水潭医院收治符合入选标准的罹患乳腺癌根治术后胸部放射性溃疡的女性患者27例,其年龄为37~83岁,其中7例患者出现胸部区域明显疼痛。完善各项检查,准确评估有无肿瘤以及放射性溃疡累及深度。排除肿瘤复发后,对溃疡创面行彻底清创(清创后创面大小为8 cm×7 cm~18 cm×18 cm),同时行创面组织病理学检查与创面组织/分泌物标本细菌培养,清创后同期或行负压封闭引流(VSD)治疗1周后行创面修复手术。根据创面位置与大小、患者年龄与全身情况,以及供区损伤最小化原则,选择最适合的组织瓣修复创面,对供区创面行断层皮片移植或拉拢缝合。记录放射性损伤累及层次与组织结构、移植组织瓣类型及大小,统计术后创面组织病理学检查及创面组织/分泌物标本细菌培养结果、疼痛缓解情况、组织瓣成活情况及创面愈合情况。随访时,观察组织瓣外形、溃疡是否复发、供区创面愈合情况及腹直肌肌皮瓣供区是否发生腹壁疝。结果放射性损伤累及肋骨与肋软骨者21例,累及肋骨、胸骨与锁骨者4例,累及锁骨及锁骨下动脉者2例。12例患者移植了腹直肌肌皮瓣,8例患者移植了背阔肌肌皮瓣,3例患者移植了胸廓内动脉穿支皮瓣,3例患者移植了腹壁上动脉穿支皮瓣,1例患者移植了游离腹壁下动脉穿支皮瓣,组织瓣大小为14 cm×8 cm~20 cm×20 cm。术后,创面组织病理学检查未见肿瘤成分;创面组织/分泌物标本细菌培养结果:25例患者为阳性,2例患者为阴性;7例患者疼痛完全缓解。25例患者术后组织瓣完全成活,创面愈合;2例患者术后腹直肌肌皮瓣尖端部分坏死,经行清创与组织瓣修整术后愈合。随访6个月~2年,组织瓣外形均良好,溃疡均未�Objective To explore the repair strategy of chest radiation ulcer after radical mastectomy for breast cancer and its clinical effect.MethodsThe study was a retrospective observational study.From September 2020 to September 2023,27 female patients(aged 37-83 years)with chest radiation ulcers after radical mastectomy for breast cancer who met the inclusion criteria were admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University,of which 7 patients developed significant pain in the chest region.Various examinations were completed to accurately assess the presence of tumors and depth of radiation ulcers.After tumor recurrence was ruled out,the ulcer wounds were thoroughly debrided(the wound size after debridement was 8 cm×7 cm to 18 cm×18 cm).At the same time,pathological examination of the wound tissue and bacterial culture of the wound tissue/exudate samples were performed.The wound repair surgery was performed at the same time after debridement or one week after vacuum sealing drainage(VSD)treatment.Based on the location and size of the wound,the age and overall condition of the patient,as well as the principle of minimizing damage to the donor site,the most suitable tissue flap was selected to repair the wound.The donor site wound was transplanted with a split-thickness skin graft or sutured together.The level and tissue structure of radiation injury,and the type and size of transplanted tissue flap were recorded.The results of postoperative pathological examination of wound tissue and bacterial culture of wound tissue/exudate samples,pain relief,survival of tissue flap,and wound healing were recorded.During the follow-up,the shape of the tissue flap,whether the ulcer recurred,the wound healing of the donor site,and whether the abdominal wall hernia occurred in the donor site of the rectus abdominis myocutaneous flap were observed.ResultsRadiation injury involved ribs and costal cartilage in 21 cases,ribs,sternum,and clavicle in 4 cases,and clavicle and subclavian artery in 2 cases.Twelve p

关 键 词：胸部 辐射损伤 慢性病 清创术 外科皮瓣 创面修复 

分 类 号：R737.9[医药卫生—肿瘤] R730.55[医药卫生—临床医学]