摘要
目的探讨乳腺癌根治术后即时乳房再造的肿瘤治疗和形体完美双重效果。方法对1999年1月至2005年7月病理证实为乳腺癌的150例患者[均为女性,年龄49±15岁,肿瘤大小(1.6±1.2)cm,腋窝未及淋巴结]行乳腺全切除(包括传统改良根治11例,保留乳房皮肤的改良根治12例,保留乳头、乳晕的改良根治127例)后,即时行乳房再造[I期背阔肌皮瓣再造139例,下腹横形腹直肌皮瓣(TRAM)再造11例]。结果手术成功149例,失败1例(损伤血管),术后并发腹壁疝1例,乳房出现脂肪结节6例,脂肪液化3例,腹部切口延迟愈合3例,背部血肿28例,切口边缘局部皮肤坏死7例,移植物缺血坏死1例(再次手术切除),乳头坏死4例。本组随访到123例,随访率82%,平均随访时间36.6月,发生腋窝淋巴结转移2例,骨转移1例,锁骨上淋巴结转移1例,死亡1例(因转移自杀),无局部复发,术后外形改变(按JCRT标准):优、良、中、差分别为11.5%、49.3%、36.7%、2.6%。结论乳腺癌根治术后即时乳房再造联合辅助治疗对早中期乳腺癌是可行的,能达到治疗和美容效果。
Objective To explore the prognostic factors and desirable effect of immediate postmastectomy reconstruction for breast cancer patients. Methods One hundred and fifty women with breast cancer diagnosed pathologically, with mean age of 49±15 years and the tumor size 1.6±1.2 cm （no palpable lymph node）, were operated on from Jan, 1999 to Jul, 2005 in Zhongshan Hospital. Mastectomy including traditional modified mastectomy in 11 cases, skin sparing modified mastectomy in 12 cases, nipple-areolar sparing modified mastectomy in 127 cases, was car- ried out. Breast reconstruction with latissimus dorsi myocutaneous flaps was performed in 139 cases and transverse rec- tus abdominis myocutaneous （TRAM） flaps breast reconstruction in 11 cases. Results Operation was successful in 149 cases; one case failed because of vessel damage, and other complications included herniation in the abdominal wall （ 1 case）, palpable adipose mass in breast （6 cases）, fat necrosis （ 3 cases）, delayed wound healing of the abdominal trauma （3 cases）, hematomas in the back （28 cases）, limited skin necrosis （7 cases）, implant loss （1 case with flap removed） and nipple necrosis （1 case）. The follow up rate was 82% （123 cases）, with an average time of 36.6 months. The results revealed axillary lymph node metastasis in 2 cases, bone metastasis in 1 case, supra clavicu- lar lymph node metastasis in 1 case and one women suicided. No local recurrence was found. We used the JCRT classi- fication to evaluate the postoperative change of the shape, which showed best result 11.5%, good 49.3%, average 36.7%, poor 2.6% in best, good, average, poor results, separately. Conclusion Immediate postmastectomy recon- struction for breast cancer with adjuvant treatments is feasible and can obtain good therapeutic and cosmetic effect for patients with early breast cancer.
出处
《中华乳腺病杂志（电子版）》
CAS
2007年第3期21-23,共3页
Chinese Journal of Breast Disease(Electronic Edition)
关键词
乳腺癌
Ⅰ期乳房再造
Breast neoplasms
Immediate breast reconstruction
