目的

探讨乳腺象限或大区段切除术中应用侧胸壁脂肪筋膜瓣即刻乳房成形的疗效及可行性。

方法

回顾性分析2014 年2 月至2015 年11 月安徽省肿瘤医院乳腺外科收治的96 例行乳腺象限或大区段切除术的乳腺良性疾病患者临床资料,其中43 例术中即刻应用侧胸壁脂肪筋膜瓣修复乳房外形(乳房成形组),37 例未行侧胸壁脂肪筋膜瓣乳房成形(非乳房成形组),16 例行皮下腺体切除术即刻假体植入重建乳房(假体重建组)。 比较3 组患者的手术相关特征、并发症及美容效果。 偏态分布的数据用M(P₂₅ ～P₇₅)表示, 组间比较采用多个独立样本的非参数检验(Kruskal-Wallis 检验),组间多重比较采用Nemenyi 检验。

结果

乳房成形组患者手术时间比假体重建组短[70.0(60.0 ～80.0) min比96.0(90.5 ～101.5) min,χ²=-4.338,P＜0.017]。 并且,乳房成形组患者的住院时间与非乳房成形组相似[11.0 (10.0 ～14.0) d 比11.0 (9.5 ～12.0) d,χ²=1.080,P＞0.017]。 乳房成形组患者术后住院时间明显比假体重建组短[8.0 (7.0 ～10.0) d 比10.0(8.3 ～11.0) d,χ²=2.644,P＜0.017],其引流管留置时间也无明显增加(χ²=3.176,P=0.204)。 术后随访3 ～24 个月(中位随访13 个月),乳房成形组、非乳房成形组、假体重建组各感染5、3、0 例,差异无统计学意义(χ²=1.640,P=0.486)。 乳腺成形组患者术后总体满意度评分为9.2(9.0 ～9.5)分,优于非乳房成形组的8.5(7.3 ～8.7)分(χ²=7.388,P＜0.017)。

结论

对于需要行乳腺象限或大区段切除术的乳腺良性疾病患者,术中应用侧胸壁脂肪筋膜瓣修复乳房外形具有技术可行、美容效果好的优点,宜于临床推广应用。

Objective

To investigate therapeutic effect and feasibility of immediate mammaplasty with lateral thoracic steato-fascia flap in segmental or quadrant mastectomy.

Methods

We retrospectively studied clinicopathologic data of 96 patients with benign diseases who underwent segmental or quadrant mastectomy in Department of Breast Surgery, Anhui Provincial Cancer Hospital from February 2014 to November 2015,including 43 patients who received segmental or quadrant mastectomy and immediate mammaplasty with lateral thoracic steato-fascia flap (mammaplasty group) and 37 patients who received segmental or quadrant mastectomy without breast mammaplasty (non-mammaplasty group) and 16 patients had subcutaneous mastectomy and immediate breast reconstruction with prosthesis implantation (breast reconstruction group).The clinical characteristics, complications and cosmetic effects were compared among 3 groups. The data with skewed distribution were expressed as M (P₂₅-P₇₅). The multiple independent samples were analyzed by Kruskal-Wallis test. Nemenyi test was used for multiple comparisons between groups.

Results

The operation time in mammaplasty group was 70.0 (60.0-80.0) min, less than 96.0 (90.5-101.5) min in breast reconstruction group (χ²=-4.338, P＜0.017). The hospitalization stay was not significantly different between mammaplasty group and non-mammaplasty group [11.0 (10.0-14.0) d vs 11.0 (9.5-12.0) d, χ²=1.080,P＞0.017]. The postoperative hospitalization stay in breast reconstruction group was 10.0 (8.3-11.0) d,significantly longer than 8.0 (7.0-10.0) d in breast mammaplasty group (χ² =2.644, P ＜0.017). The drainage time was not significantly different among three groups (χ² =3.176,P=0.204). All patients were followed up for 3-24 months (median 13 months). Five patients had infection in mammaplasty group, 3 in non-mammaplasty group, 0 in breast reconstruction group, respectively, indicating no significant difference(χ²=1.640, P=0.486). The overall aesthetic score in mammaplasty group was 9.2(9-9.5), significantly higher than 8.5(7.3-8.7) in non-mammaplasty group (χ² = 7.388,P ＜0.017).

Conclusion

For the patients with breast benign diseases requiring segmental or quadrant mastectomy, immediate mammaplasty with lateral thoracic steato-fascia flap is easy to operate and feasible, with good cosmetic effect, which is worthy of clinical application.