乳腺癌腔镜辅助下背阔肌肌瓣乳房重建术临床疗效分析  

Clinical analysis of breast reconstruction with endoscopic-assisted harvesting of latissimus dorsi muscle flap for breast cancer

作　　者：李江涛 刘晨璐 欧欣瑜 陆艺文 苏士成[1] 刘志瀚[1] LI Jiangtao;LIU Chenlu;OU Xinyu;LU Yiwen;SU Shicheng;LIU Zhihan(Breast Tumor Center Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou Guangdong,510120,P.R.China)

机构地区：[1]中山大学孙逸仙纪念医院乳腺肿瘤中心,广州510120

出　　处：《中国修复重建外科杂志》2024年第7期801-806,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨乳腺癌腔镜辅助下背阔肌肌瓣乳房重建术的优缺点及手术相关并发症。方法回顾分析2021年9月—2023年3月收治且符合选择标准的26例女性乳腺癌患者临床资料。患者年龄26~69岁,平均48.7岁。肿瘤均为单侧,左侧17例,右侧9例。原发肿瘤直径1.0~7.0 cm,平均2.7 cm。肿瘤病理分期:T111例、T214例、T31例;N010例、N111例、N22例、N33例;初诊时无患者发生远处转移(M0)。其中10例行保乳手术,16例行保留乳头乳晕的皮下全切术;术后均行腔镜辅助下背阔肌肌瓣乳房重建术。记录手术时间、切口长度及术后3 d引流量;术后6个月采用Breast-Q评分量表中的背部满意度问卷评估患者对背部手术的满意度。结果手术时间280~480 min,平均376.7 min;切口长度10~15 cm,平均12.2 cm;术后3 d引流量500~1600 mL,平均930.2 mL。术后发生血清肿4例,切口裂开1例,胸壁麻木1例,患侧上肢水肿1例。26例患者均获随访,随访时间12~30个月,平均20.1个月。随访期间未出现背阔肌肌瓣坏死、背阔肌萎缩及肩关节活动障碍;2例患者术后患侧腋窝淋巴结复发,均无远处转移发生。术后6个月,Breast-Q评分量表中的背部满意度评分为64~100分,平均79.5分;其中行保留乳头乳晕的皮下全切术患者满意度评分为64~100分、平均78.6分,行保乳术患者满意度评分为78~100分、平均81.0分。结论乳腺癌腔镜辅助下背阔肌肌瓣乳房重建术后手术相关并发症较轻,美容效果良好,是一种兼具安全性及美容性的术式。Objective To investigate the benefits and drawbacks of breast reconstruction with endoscopicassisted harvesting of the latissimus dorsi muscle flap for breast cancer and treatment experience of postoperative operation-related complications.Methods A retrospective analysis was performed on clinical data of 26 female patients with breast cancer who met the selection criteria between September 2021 and March 2023 aging 48.7 years(range,26-69 years).All tumors were unilateral,with 17 on the left side and 9 on the right side.The tumor size ranged from 1.0 to 7.0 cm,with an average of 2.7 cm.The pathological staging included T1 in 11 cases,T2 in 14 cases,and T3 in 1 case;N0 in 10 cases,N1 in 11 cases,N2 in 2 cases,and N3 in 3 cases;no distant metastasis(M0)occurred when first diagnosed.Among them,10 cases underwent breast conserving surgery,and 16 cases underwent nipple-sparing mastectomy.All patients underwent breast reconstruction with endoscopic-assisted harvesting of the latissimus dorsi muscle flap.The operation time,incision length,and postoperative drainage volume in 3 days were recorded.Breast-Q“Satisfaction with back”scale was conducted to evaluate patients’satisfaction with back at 6 months after operation.Results The operation time was 280-480 minutes(mean,376.7 minutes),the incision length was 10-15 cm(mean,12.2 cm),the postoperative drainage volume in 3 days was 500-1600 mL(mean,930.2 mL).There were 4 cases of postoperative seroma,1 case of incision rupture,1 case of paresthesia of the thoracic wall,and 1 case of edema of the ipsilateral upper limb.All patients were followed up 12-30 months(mean,20.1 months).No latissimus dorsi muscle flap necrosis,latissimus dorsi muscle atrophy,or shoulder joint dysfunction occurred during follow-up;2 patients had recurrence of lymph nodes in the ipsilateral axilla after operation,but no distant metastasis occurred.Breast-Q score at 6 months after operation was 64-100(mean,79.5).The average score was 78.6(range,64-100)in patients underwent nipple-sparing mastectomy

关 键 词：乳腺癌 乳房重建 背阔肌肌瓣 单孔腔镜 

分 类 号：R737.9[医药卫生—肿瘤]