乳腺癌改良根治术后即刻乳房重建的方式选择

doi:10.19723/j.issn.1671-167X.2023.04.007

摘要/Abstract

摘要：

目的: 探讨乳腺癌改良根治术后即刻乳房重建的方法选择及效果。方法: 回顾分析2009年1月至2019年5月北京大学第三医院成形外科与普外科合作开展的乳腺癌改良根治术后行即刻乳房重建患者的相关信息，对重建的方式及术后效果进行分析，对即刻乳房重建的安全性进行评价。结果: 共123例患者纳入研究。根据患者肿瘤临床分期、乳房皮肤切除量、对侧乳房大小、身体状况、患者意愿等不同情况，采取不同乳房重建方式。其中采用组织扩张后乳房假体置换79例，单纯乳房假体置入23例，背阔肌肌皮瓣结合乳房假体置入7例，下腹部横形腹直肌肌皮瓣重建5例，组织扩张后假体结合内窥镜下背阔肌肌瓣移转6例，组织扩张后转为腹壁下动脉穿支皮瓣重建3例。术后平均随访(12.3±9.0)个月(3.5~41.0个月)，Harris评价方法外形评价为“优”以上者占90.2%。结论: 选择适宜病例行乳腺癌改良根治术后的即刻乳房重建是安全可行的，方式可根据个体的不同情况进行个性化选择，恰当的重建方式可达到满意的临床效果。

关键词: 乳腺肿瘤, 乳腺切除术, 改良根治性, 修复外科手术

Abstract:

Objective: To investigate the choice of immediate breast reconstructive methods and asso-ciated outcomes after modified radical mastectomy. Methods: Retrospective analysis of patients undergoing immediate breast reconstruction after modified radical mastectomy in Peking University Third Hospital from January 2009 to May 2019. The reconstructive methods were summarized, and the clinical outcomes and the safety of immediate breast reconstruction were evaluated. Results: One hundred and twenty-three patients were enrolled in this study. Different reconstructive methods were applied according to the clinical stage, the amount of skin removal, the size of contralateral breasts, the physical condition and the preference of the patients. Seventy-nine cases were performed with tissue expander/implant two-stage reconstruction, twenty-three cases received direct breast implant insertion, seven cases were applied for latissimus dorsi (LD) myocutaneous flap transfer combined with implant insertion, five cases were provided transverse rectus abdominis myocutaneous (TRAM) flap transfer, six cases underwent tissue expander/implant combined with endoscopic LD muscle flap transfer, and three cases chose tissue expander/deep inferior epigastric artery perforator (DIEP) flap transfer. The average follow-up time was (12.3±9.0) months (3.5-41.0 months). One patient with direct implant insertion had partial blood supply distur-bance of the mastectomy flap. One case had necrosis of distal end of TRAM zone Ⅳ. One patient with expander/DIEP reconstruction had partial fat liquefaction. And two cases had expander leakage at the end of the expansion period. The tumor local recurrence occurred in one patient, and the implant was finally removed. The outcomes were evaluated by Harris method, and 90.2% patients were good or above in shape evaluation. Among the patients with implant based reconstruction, there was no obvious capsular contracture, and most of the implants had good or fair mobility. Conclusion: It is safe and feasible of immediate breast reconstruction after modified radical mastectomy for appropriate cases. The reconstructive methods can be individualized according to the individual's different conditions. The appropriate reconstructive methods could achieve satisfactory results.

Key words: Breast neoplasms, Mastectomy, modified radical, Reconstructive surgical procedures

中图分类号:

R655.8

马建勋,夏有辰,李比,赵红梅,雷玉涛,布希. 乳腺癌改良根治术后即刻乳房重建的方式选择[J]. 北京大学学报（医学版）, 2023, 55(4): 612-618.

Jian-xun MA,You-chen XIA,Bi LI,Hong-mei ZHAO,Yu-tao LEI,Xi BU. Choice of immediate breast reconstructive methods after modified radical mastectomy[J]. Journal of Peking University (Health Sciences), 2023, 55(4): 612-618.

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参考文献 21

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Items	n(%)
Methods of immediate breast reconstruction (n=123)
Tissue expander / implant	79 (64.2)
Implant	23 (18.7)
LDMCF + implant	7 (5.7)
Tissue expander / LDMF + implant	6 (4.9)
TRAM	5 (4.1)
Tissue expander / DIEP flap	3 (2.4)
Implant (n=115)
Anatomical	108 (93.9)
Round	7 (6.1)
Surgery on the contralateral breast (n=123)
Breast augmentation with implant	4 (3.3)
Breast augmentation with autologous fat	4 (3.3)
Mastopexy	6 (4.9)
Breast reduction	1 (0.8)
None	108 (87.7)
Complication
Leakage of expander	2 (2/88, 2.3)
Blood supply disorder of chest wall skin	1 (1/123, 0.8)
Fat necrosis of DIEP flap	1 (1/3, 33.3)
Necrosis of distal end of TRAM zone Ⅳ	1 (1/5, 20.0)
Harris evaluation^[7] (n=122)
Perfect	16 (13.1)
Good	94 (77.1)
Fine	12 (9.8)
Poor	0
Capsular contraction (n=114)
Baker grade Ⅰ	8 (7.0)
Baker grade Ⅱ	94 (82.5)
Baker grade Ⅲ	12 (10.5)
Baker grade Ⅳ	0
Prosthesis mobility (n=114)
Excessive	0
Good	18 (15.8)
Fair	68 (59.6)
Fixed	28 (24.6)