探讨乳腺区段切除术后缺损区组织瓣移位的手术效果。

回顾分析2003年5月至2010年8月武警总医院收治的64例行乳腺区段切除术的浆细胞性乳腺炎和多个导管内乳头状瘤患者的临床资料。采用组织瓣移位技术，在乳腺区段切除术后缺损区用残余的乳腺腺体组织、脂肪组织及皮肤组成的组织瓣进行填充，并分析组织瓣移位术后并发症及乳房外观效果。

64例患者施行乳腺缺损区组织瓣移位术后均达到乳房外观协调。病灶切除范围>1个象限、<2个象限者22例和多个导管内乳头状瘤切除范围≥2个象限、<3个象限者2例，行组织瓣移位术后乳房外观基本良好，与健侧乳房对称；乳腺区段切除范围≥2个象限、<3个象限者21例，行组织瓣移位术后乳房外观变化明显，与对侧比较，有局部缺损表现且不对称；切除范围≥3个象限者19例，患侧乳房整体比对侧小，明显不对称。术后仅1例发生乳腺脂肪部分坏死，经微创旋切术取除坏死组织后治愈。随访时间达4～10年，中位随访时间为6年，患侧乳房、乳头均无凹陷，患者均满意。

乳腺区段切除术后缺损区组织瓣移位术是可行的，避免了全乳切除且效果满意。

To study the outcome of tissue flap transplantation in defect area after segmental mastectomy.

The clinical data of 64 patients with plasma cell mastitis and multiple intraductal papilloma who underwent segmental mastectomy in General Hospital of Chinese People’s Armed Police from May 2003 to August 2010 were retrospectively analyzed. The defect area after segmental mastectomy was filled with a tissue flap consisting of residual mammary tissue, adipose tissue and skin. The postoperative complications and appearance of the wound were analyzed.

The breast showed an acceptable appearance after tissue flap transplantation in 64 patients. There were 22 patients with resected lesion > 1 quadrant but < 2 quadrants, and 2 patients with resected area of multiple intraductal papilloma≥2 quadrants but < 3 quadrants, and all repaired breasts presented a good appearance and were symmetrical to the healthy breast after tissue flap transplantation. Twenty-one patients had the resected range of the breast ≥ 2 quadrants but<3 quadrants and the breast appearance was obviously changed after tissue flap transplantation, with local defect and asymmetric to the healthy breast. Nineteen patients with resected lesion≥3 quadrants had a remarkably smaller breast, which was asymmetrical to the healthy breast. Only 1 case developed the necrosis of adipose tissue after operation and was cured by minimally invasive excision of necrotic tissue. They were followed up for 4-10 years, median 6 years. There was no collapse in the nipple and the whole affected breast. The outcome was satisfactory.

The tissue flap transplantation in the defect area after segmental mastectomy is feasible, which can avoid total mastectomy and achieve satisfactory outcome.