探讨应用侧胸壁筋膜皮瓣修复乳房外侧象限局部缺损的可行性及美容效果。

回顾性分析2016年7月至2018年7月郴州市第一人民医院乳腺甲状腺外科收治的外侧象限乳腺疾病患者46例，其中乳腺癌30例、肉芽肿性乳腺炎10例和交界性叶状肿瘤6例。观察组(26例)采用侧胸壁筋膜皮瓣修复局部缺损，对照组(20例)采用切缘周围脂肪筋膜瓣移位成形修复局部缺损。采用t检验比较2组患者年龄、肿瘤直径、残腔大小、切口长度、手术时间、出血量、引流管留置时间；采用χ²检验比较2组患者肿瘤位置、TNM分期、并发症发生率；采用Kruskal-Wallis秩和检验比较2组患者术后美容效果。

2组患者的手术切口长度和引流管留置时间比较，差异有统计学意义(t＝18.143、2.197，P均<0.050)。观察组和对照组术后并发症发生率为15.4%(4/26)和20.0%(4/20)，2组比较，差异无统计学意义(χ²＝0.000，P＝0.986)。术后美容效果评价显示观察组优良率为96.2%(25/26)，对照组优良率为70.0%(14/20)，2组患者优良率比较，差异有统计学意义(χ²＝4.138，P＝0.042)。术后2组患者美容效果评价比较，差异有统计学意义(H＝6.528，P＝0.038)。术后所有患者中位随访24个月(12~36个月)，均无局部复发及远处转移。

采用侧胸壁筋膜皮瓣修复乳房外侧象限局部缺损是可行的，手术可操作性强、创伤小，切口隐蔽及美容效果好，值得临床推广。

To explore the feasibility and cosmetic effect of lateral thoracodorsal fasciocutaneous flap for repairing local defects in lateral breast quadrant.

The clinical data of 46 patients with breast diseases in lateral breast quadrant, including 30 patients with breast cancer, 10 granulomatous mastitis and 6 borderline phyllodes tumors, in the Department of Breast and Thyroid Surgery, First People’s Hospital of Chenzhou from July 2016 to July 2018 were retrospectively analyzed. They were divided into two groups: observation group and control group. In all 26 patients of observation group, local defect was repaired with the lateral thoracodorsal fasciocutaneous flap. In all 20 patients of control group, the lipofascial flap around the incision edge was used to repair local defect. t test was used to compare age, tumor diameter, residual cavity size, incision length, operation time, blood loss and drainage tube duration between two groups.χ² test was used to compare tumor location, TNM stage and complication rate between two groups. Kruskal-Wallis test was used to compare postoperative cosmetic effect between two groups.

There was no significant difference in age, tumor diameter, residual cavity size, tumor location and TNM stage between two groups, indicating comparability. There was a significant difference in incision length and drainage tube duration between two groups (t=18.143, 2.197; P all<0.050). The incidence of postoperative complications was 15.4% (4/26) in observation group and 20.0% (4/20) in control group, indicating no significant difference between two groups (χ²=0.000, P=0.986). The evaluation of postoperative cosmetic effect showed that the proportion of patients with excellent and good cosmetic effect was 96.2%(25/26)in observation group, and 70%(14/20)in control group, indicating a significant difference between two groups (χ²=4.138, P=0.042). There was a signifcant difference in postoperative cosmetic effect between two groups (H=6.528, P=0.038). All patients were followed up for median 24 months (range: 12 to 36 months), and no local recurrence or distant metastasis was observed.

The surgical repair of local defects in lateral breast quadrant using lateral thoracodorsal fasciocutaneous flap is feasible, easy to operate, with small trauma, occult incision and good cosmetic effect, which is worthy of clinical application.