目的

探讨乳腺癌改良根治术后应用扩展型背阔肌肌皮瓣即时乳房重建的疗效。

方法

对27例乳腺癌患者施行乳腺癌改良根治术(其中6例行保留皮肤的乳腺癌改良根治术,21例行保留乳头、乳晕的乳腺癌改良根治术),术后即时切取包括背阔肌及其表面的脂肪和岛状皮肤、髂嵴上方脂肪、背阔肌前沿侧胸部脂肪和肩胛区脂肪构成扩展型背阔肌肌皮瓣,转移至胸壁重建乳房。

结果

27例即时乳房重建全部获得成功。切除乳房的组织量为180～330 ml(平均215 ml),移植重建乳房的扩展型背阔肌肌皮瓣组织量为210～380 ml(平均245 ml)。24例术后辅助化疗,5例辅助放射治疗。随访6～24个月(中位随访12个月),所有患者均生存,术后无一例局部复发、转移。美容效果:优17例,良6例,一般3例,差1例。

结论

乳腺癌患者行保留皮肤或乳头乳晕改良根治术后应用扩展型背阔肌肌皮瓣即时乳房重建形态良好,不影响术后辅助治疗和远期疗效,作为目前乳腺肿瘤治疗的一种有效补充手段,值得临床推广。

Objective

To study the therapeutic effects of immediate breast reconstruction using extended latissimus dorsi(ELD)musculocutaneous flap after skin-sparing or nipple-sparing modified radical mastectomy.

Methods

The skinsparing modified radical mastectomy was carried out in 6 patients and the nipplesparing modified radical mastectomy in 21 patients.The latissimus dorsi muscle and its surface fat and island skin,iliac crest fat,the fate from the front edge to the side chest,and the fat of the scapular region were cut immediately after the surgery.And immediate breast reconstruction was performed with ELD musculocutaneous flap for all patients.

Results

All patients obtained successful breast reconstruction.The resected tissue volumes of mastectomy were 180-330 ml(mean 215 ml)and the ELD musculocutaneous flap volume for breast reconstruction was 210-380 ml(mean 245 ml).Twenty-four patients received adjuvant chemotherapy and 5 patients received adjuvant radiation therapy.All the patients were followed up for 6-24 months(mean 12 months),and all the patients survived.No patient had metastasis or recurrence.As for the cosmetic effect of the reconstructed breasts,excellent result was in 17cases,good in 6 cases,fair in 3 cases and poor in 1 case.

Conclusion

ELD musculocutaneous flap can provide enough tissue for immediate breast reconstruction after skin-sparing and nipple-sparing modified radical mastectomy in patients with breast cancer.The shape of reconstructed breasts is good.Immediate breast reconstruction with ELD musculocutaneous flap does not influence adjuvant therapy and long-term therapeutic effect.