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中华乳腺病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (04) : 247 -252. doi: 10.3877/cma.j.issn.1674-0807.2022.04.010

综述

容积替代技术在乳腺癌保留乳房手术中的应用
唐朝易1,(), 韦德飞1, 卿佳林1   
  1. 1. 545000 柳州市人民医院乳腺甲状腺外科二病区
  • 收稿日期:2021-07-24 出版日期:2022-08-01
  • 通信作者: 唐朝易

Oncoplastic volume replacement in breast­conserving surgery of breast cancer patients

Chaoyi Tang1(), Defei Wei1, Jialin Qing1   

  • Received:2021-07-24 Published:2022-08-01
  • Corresponding author: Chaoyi Tang
引用本文:

唐朝易, 韦德飞, 卿佳林. 容积替代技术在乳腺癌保留乳房手术中的应用[J]. 中华乳腺病杂志(电子版), 2022, 16(04): 247-252.

Chaoyi Tang, Defei Wei, Jialin Qing. Oncoplastic volume replacement in breast­conserving surgery of breast cancer patients[J]. Chinese Journal of Breast Disease(Electronic Edition), 2022, 16(04): 247-252.

保留乳房手术在保证肿瘤安全性的同时保留了女性乳房外观,提高了患者生活质量。在肿瘤较大和肿瘤位于乳房内上象限的患者中,采用传统保留乳房手术或容积移位技术并不能达到良好的术后外观。容积替代技术采用乳腺外自体组织瓣对保留乳房手术中肿瘤扩大切除导致的残余腔隙进行填充,实现部分乳房重建。对于不同象限肿瘤,可采用相应区域皮瓣完成保留乳房整形手术。随着穿支血管解剖技术的成熟,带蒂穿支皮瓣因为操作简单、供区损伤小等优势已成为保留乳房手术的首选。笔者对保留乳房手术中运用的容积替代技术进行总结,阐述其解剖学特征及手术要点,对比了不同术式的优缺点,以供同行参考。

图1 背阔肌血供解剖示意图注:1为胸腰椎;2为肱骨;3为肋间动脉分支;4为胸背动脉穿支;5为胸背动脉降支
图2 胸背动脉降支微型肌皮瓣修复乳房部分缺损的示意图注:1为乳腺缺损区;2为胸背动脉前锯肌分支;3为胸背动脉横支;4为胸背动脉降支;5为胸背动脉降支微型肌皮瓣
图3 肋间动脉外侧穿支解剖示意图注:1为椎体;2为主动脉;3为肋骨;4为胸骨;PICAP为肋间动脉背侧穿支;LICAP为肋间动脉外侧穿支;AICAP为肋间动脉前穿支
图4 肋间动脉外侧穿支皮瓣修复乳房缺损的示意图注:1为乳腺缺损区;2为肋间动脉外侧穿支皮瓣;3为肋间动脉外侧穿支血管
图5 胸外侧动脉穿支皮瓣修复乳房缺损示意图注:1是乳腺缺损区;2是胸外侧动脉穿支皮瓣;LTA是胸外侧动脉;TDA是胸背动脉
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