探讨自体组织乳房重建术式对乳腺叶状肿瘤患者术后胸壁缺损修复的应用价值。

本研究分析了2016~2022年贵州医科大学附属医院和湖南省肿瘤医院收治的7例乳腺叶状肿瘤患者的临床资料。其中，4例为巨大叶状肿瘤，3例为叶状肿瘤所占乳房体积比例较大。7例均在乳房切除术后行一期自体组织乳房重建，其中3例使用腹壁下动脉穿支皮瓣(DIEP)移植、4例使用带蒂的横行腹直肌肌皮瓣(TRAM)转移。记录7例患者的手术时间、出血量及术后并发症。术后3个月采用自制量表评估术后乳房美容效果。

7例患者中位手术时间为417 min，中位出血量为41 ml。术后病理结果显示恶性叶状肿瘤患者4例，其中1例行DIEP移植、3例行TRAM转移；交界性叶状肿瘤3例，2例行DIEP移植、1例行TRAM转移。皮瓣全部存活，术区创面修复效果良好，未出现感染、切口开裂、腹壁疝等并发症。截止2022年6月，术后随访时间11~77个月，中位随访时间41个月，所有患者均存活，无复发、转移。术后3个月乳房美容效果评分6分4例、5分2例、4分1例。

手术治疗是乳腺叶状肿瘤患者的有效治疗方式，DIEP或TRAM皮瓣对于乳腺叶状肿瘤切除术后胸壁缺损的修复效果良好，适用于瘤体过大而无法在术后原位缝合的乳腺叶状肿瘤患者。

To explore the application of autologous breast reconstruction in the repair of chest wall defects in patients with breast phyllodes tumor after surgery.

In this study, we analyzed the clinical data of seven patients with breast phyllodes tumor in the Affiliated Hospital of Guizhou Medical University and Hunan Cancer Hospital in 2016-2022. Among them, four patients had giant phyllodes tumors, and three patients showed a high tumor-to-breast volume ratio. All patients underwent primary autologous breast reconstruction after mastectomy, of which three cases received deep inferior epigastric perforator flap (DIEP) transpaltation and four cases received pedicled transverse rectus abdominis musculocutaneous flap (TRAM) transfer. The operation time, blood loss and postoperative complications of all patients were recorded. A self-designed scale was used to evaluate the cosmetic effect of the breast at 3 months after surgery.

The median operation time of all patients was 417 minutes and the median blood loss was 41 ml. Postoperative pathological results showed that four patients had malignant phyllodes tumors (one case underwent DIEP transplantation and three cases underwent TRAM transfer), and three patients had borderline phyllodes tumors (two cases underwent DIEP transplantation, and one case underwent TRAM transfer. All the flaps survived, with good wound repair effect in the surgical area. There were no complications such as infection, rupture of incision and abdominal wall hernia. Until June 2022, they were followed up for 11-77 months (median 41 months). All patients survived, with no recurrence or metastasis. The score for cosmetic effect of the breast was 6 in 4 cases, 5 in 2 cases and 4 in 1 case at 3 months after surgery.

Surgery is effective treatment for patients with breast hyllodestumors. Autologous breast reconstruction by DIEP or TRAM flaps shows good effect on the repair of chest wall defects after tumor resection, which is feasible for giant phyllodes tumors unsuitable for suture in situ after surgery.