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中华乳腺病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 172 -178. doi: 10.3877/cma.j.issn.1674-0807.2023.03.008

综述

肿瘤整形保留乳房手术的临床应用
任嘉辉, 唐仁檄, 杨玲, 王元元, 张翔, 厉红元()   
  1. 400061 重庆医科大学附属第一医院乳腺甲状腺外科
  • 收稿日期:2022-07-12 出版日期:2023-06-01
  • 通信作者: 厉红元

Clinical application of oncoplastic breast conserving surgery

Jiahui Ren, Renxi Tang, Ling Yang   

  • Received:2022-07-12 Published:2023-06-01
引用本文:

任嘉辉, 唐仁檄, 杨玲, 王元元, 张翔, 厉红元. 肿瘤整形保留乳房手术的临床应用[J]. 中华乳腺病杂志(电子版), 2023, 17(03): 172-178.

Jiahui Ren, Renxi Tang, Ling Yang. Clinical application of oncoplastic breast conserving surgery[J]. Chinese Journal of Breast Disease(Electronic Edition), 2023, 17(03): 172-178.

保留乳房手术联合辅助放射治疗是早期乳腺癌的标准治疗手段之一,与乳房切除手术的预后类似。然而,在肿瘤较大、边界不清、多灶性或位置不佳的患者中,传统保留乳房手术常导致术后乳房畸形和不对称,甚至在较小乳房的患者中也可能出现类似的问题。肿瘤整形保留乳房手术解决了这些问题,容积移位和容积替代技术兼顾了外科手术的无瘤原则和乳房的美学效果,提高了患者的满意度和生活质量,使得更多的患者获得了保留乳房的机会,但其肿瘤安全性仍有待进一步探索。笔者就肿瘤整形保留乳房手术的优缺点、常见手术方式及其对肿瘤安全性的影响等方面进行总结,以帮助临床医师做出更合适的个性化选择。

图1 双环法保留乳房整形手术示意图 a图所示术前切口设计、肿瘤切除和去表皮化;b图所示缝合后乳房外观
图2 网球拍法保留乳房整形手术示意图  a图所示术前切口设计、肿瘤切除和去表皮化;b图所示缝合后乳房外观
图3 J型乳房成形术的手术示意图 a图所示术前切口设计、肿瘤切除和去表皮化;b图所示缝合后乳房外观
图4 V型乳房成形术的手术示意图 a图所示术前切口设计、肿瘤切除和去表皮化;b图所示缝合后乳房外观
图5 Grisotti乳房成形术的手术示意图  a图所示术前切口设计、肿瘤切除和去表皮化;b图所示新乳头、乳晕区的重建及定位
图6 垂直切口法的手术示意图  a图所示术前切口设计、肿瘤切除和去表皮化;b图所示缝合后乳房外观
图7 倒T法(上蒂法)手术示意图  a图所示术前切口设计、肿瘤切除和去表皮化;b图所示缝合后乳房外观
图8 腔镜辅助下部分乳房切除术联合背阔肌皮瓣容积替代的示意图注:①腔镜的腋窝切口;②乳房的缺损区
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