带蒂大网膜联合硅胶假体乳房重建术后放射治疗的动物实验研究

doi:10.3877/cma.j.issn.1674-0807.2023.02.006

目的

研究放射治疗对实验犬带蒂大网膜联合硅胶假体乳房重建术的影响。

方法

选择健康本地犬20只。每只实验犬选择前腹乳房进行2种乳房重建手术，左乳行带蒂大网膜联合硅胶假体乳房重建(网膜组)，右乳行单纯硅胶假体乳房重建术(假体组)。2组于术后4周均接受同等剂量放射治疗，放射治疗后8个月取出网膜、假体及包膜。术后假体包膜挛缩发生率的组间比较采用配对χ²检验(McNemar法)，包膜厚度和包膜微血管密度的组间比较采用配对样本t检验。

结果

2组放射治疗后假体包膜挛缩率分别为25.0%(5/20)与5.0%(1/20)，组间比较，差异无统计学意义(χ²＝2.670，P＝0.219)。假体组包膜厚度高于网膜组[(1.4±0.2)mm比(0.8±0.1)mm，t＝4.173，P＝0.001]。网膜组微血管密度高于假体组[(44.3±5.1)条/高倍视野比(28.4±2.8)条/高倍视野，t＝5.202，P<0.001]。

结论

放射治疗对实验犬带蒂大网膜联合硅胶假体乳房重建术的影响较小，大网膜对硅胶假体具有保护作用。

关键词: 乳房肿瘤, 网膜, 假体和植入物, 犬, 放射治疗

Objective

To investigate the effect of radiotherapy on breast reconstruction using the pedicled omental flap combined with a silicone implant in experimental dogs.

Methods

Twenty healthy local dogs were used for the experiment. Each experimental dog underwent 2 types of breast reconstruction in anterior ventral breasts. They underwent breast reconstruction using a pedicled omental flap and a silicone implant in the left breast (the omental flap group), and prosthetic breast reconstruction only with a silicone implant in the right breast (the implant group). Four weeks after surgery, radiotherapy of the same dose was given for both breasts. Eight months after radiotherapy, the omental flap, implants and capsules were removed from the dogs. The rate of capsular contracture was compared between groups by paired χ² test (McNemar test). The thickness of capsule and microvascular density were compared between groups by paired-samples t test.

Results

The capsular contracture rate in the implant group and the omental flap group was 25.0% (5/20) and 5.0% (1/20), respectively, indicating no significant difference (χ²=2.670, P=0.219). Thickness of the capsule in the implant group was significantly higher than that in the omental flap group [ (1.4±0.2) mm vs (0.8±0.1) mm, t=4.173, P=0.001]. Microvascular density in the omental flap group was significantly higher than that in the implant group (vessels in each high power field: 44.3±5.1 vs 28.4±2.8, t=5.202, P<0.001).

Conclusion

Radiotherapy shows little effect on breast reconstruction with a pedicled omental flap and a silicone implant in experimental dogs and the omentum has a protective effect on the silicone implant.

Key words: Breast neoplasms, Omentum, Prostheses and implants, Dogs, Radiotherapy

图1 实验犬假体乳房重建手术过程　a图为犬的带蒂大网膜外观；b图为犬大网膜包裹的假体外观；c图为犬右侧乳房单纯硅胶假体乳房重建术中切除腺体后的假体植入空间；d图为犬双侧乳房重建术后外观

图2 实验犬放射治疗后假体包膜外观　a图为网膜组放射治疗后假体外观，可见包膜完好，无凹陷和挛缩；b图为假体组放射治疗后假体正面外观，黄色线框内可见包膜挛缩形成的假体皱褶和凹陷；c图为假体组放射治疗后假体背面外观，箭头所示处为导致假体包膜挛缩的纤维条索

图3 实验犬假体包膜病理图　a图为放射治疗后网膜组的假体包膜病理图，包膜厚度为0.5 mm(HE　×100)；b图为放射治疗后网膜组包膜的微血管病理图，可见丰富新生血管和血管腔(HE　×400)；c图为放射治疗后假体组的包膜病理图，包膜厚度为1.8 mm(HE　×100)；d图为放射治疗后假体组包膜的微血管病理图，数量较少(HE　×400)

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Radiotherapy following breast reconstruction using a pedicled omental flap combined with a silicone implant in dogs

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Radiotherapy following breast reconstruction using a pedicled omental flap combined with a silicone implant in dogs