目的

探讨单侧乳腺癌改良根治术同时行对侧胸廓内动脉穿支皮瓣修复巨大胸壁缺损或即刻乳房重建的可行性及临床价值。

方法

回顾分析2013 年7 月至2016 年5 月安徽医科大学第一附属医院收治8 例内乳区巨大乳腺癌患者的临床资料,其中7 例患者行新辅助化疗。 8 例患者均在单侧乳腺癌改良根治术同时行对侧胸廓内动脉穿支皮瓣修复巨大胸壁缺损(1 例)或即刻乳房重建(7 例),且8 例患者均同时行对侧乳房缩乳上提术,其中3 例患者同时联合假体乳房重建术,4 例患者同时行双侧乳头乳晕重建术。 术后予以综合治疗。 统计患者手术时间及住院时间,观察皮瓣成活情况及术后并发症,并调查患者对手术效果的满意度。

结果

平均手术时间为3.0 h(2.3 ～4.8 h)。 平均住院时间为8.9 d(7.0 ～14.0 d)。 进行了4 ～33 个月的随访,中位随访23 个月。 术后8 例皮瓣均未见坏死。1 例皮瓣淤血,1 例出现皮下积液,经过抽液后痊愈。 患者供体区域未见明显并发症,对侧乳腺未见原发乳腺癌及远处转移。 所有患者均对修复或者重建效果满意。

结论

对侧胸廓内动脉穿支皮瓣适用于特定人群的胸壁缺损修复或乳房重建,患者恢复快及供皮瓣区并发症低为其优点,尤其适用于内乳区巨大乳腺癌患者。

Objective

To explore the feasibility and clinical value of contralateral internal thoracic artery perforator flap to repair large chest wall defect or immediate breast reconstruction in unilateral modified radical mastectomy.

Methods

A retrospective analysis of eight patients with large breast cancer in internal mammary area admitted to the First Affiliated Hospital of Anhui Medical University between July 2013 and May 2016 was conducted. Seven patients received neoadjuvant chemotherapy. All 8 patients received contralateral internal thoracic artery perforator flap to repair large chest wall defect (1 case) or immediate breast reconstruction (7 cases). All 8 patients received contralateral breast reduction and lifting, including 3 with prosthesis reconstruction and 4 with bilateral nipple-areola reconstruction during operation. Comprehensive treatment was given after operation. The operation time and hospitalization time were statistically analyzed. The flap survival and postoperative complications were observed and the patients' satisfaction with the operation outcome was investigated.

Results

The average operation time was 3.0 h (range:2.3-4.8 h). The average duration of hospitalization was 8.9 d (range: 7.0-14.0 d). The median follow-up period was 23 months(range:4-33 months). The flaps survived in eight patients. Flap congestion occurred in one case. One patient suffered from subcutaneous effusion, but recovered after drainage. No obvious complications were found in donor areas. Primary breast cancer and distant metastasis were not found in the contralateral breast. All patients were satisfied with the repair and reconstruction.

Conclusions

Contralateral internal thoracic artery perforator flap can be used for large chest wall defect repair or breast reconstruction in carefully selected patients, with the advantages of rapid recovery and low donor area morbidity. It is especially suitable for the patients with large breast cancer in internal mammary area.