擴大背闊肌肌皮瓣在乳腺癌改良根治術后一期乳房再造中的應用_《中國普外基礎與臨床雜志》

作者：

王亞兵 , 陳劍平 , 陳斌

皖南醫學院附屬弋磯山醫院頸乳外科（安徽蕪湖 241001）;

關鍵詞：

乳腺癌改良根治術擴大背闊肌肌皮瓣一期乳房再造

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目的評價擴大背闊肌肌皮瓣在乳腺癌改良根治術后一期乳房再造中的應用價值。
方法選取我科2008年1月至2009年6月期間收治的48例乳腺癌患者，根據所接受的術式分為擴大背闊肌肌皮瓣一期乳房再造（乳房再造）組（n=12）和單純乳腺癌改良根治術（單純根治）組（n=36），對2組患者術后并發癥、恢復情況以及生活質量進行對比，并對再造乳房外觀形態進行評價。
結果乳房再造組患者均成功行擴大背闊肌肌皮瓣乳房再造，再造乳房外形評價良好6例，中4例，差2例, 明顯優于單純根治組（P lt;0.001）。2組患者術后積液、皮瓣壞死、患肢及肩關節活動、住院時間、引流時間及開始輔助治療時間差異均無統計學意義（P gt;0.05），但乳房再造組術后生活質量較好，與單純根治組比較差異有統計學意義（P lt;0.001）。乳房再造組有10例行術后輔助放化療，未出現轉移皮瓣壞死。2組患者隨訪2～17個月（中位時間8個月），未見局部復發及轉移。
結論乳腺癌根治術后擴大背闊肌肌皮瓣一期再造乳房形態效果良好，手術操作簡單，對早期乳腺癌是一種安全、可行的治療方法。

引用本文： 王亞兵,陳劍平,陳斌. 擴大背闊肌肌皮瓣在乳腺癌改良根治術后一期乳房再造中的應用. 中國普外基礎與臨床雜志, 2010, 17(7): 735-738. doi: 復制

1.	郭娜, 倪毅, 關煒. 乳房再造術的研究進展 [J]. 山西中醫學院學報, 2008; 9(1): 6062.
2.	尹健, 張學慧, 張斌. 即刻乳房再造與延期乳房再造的心理調查 [J]. 中華整形外科雜志, 2005; 21(3): 175177.
3.	狄根紅, 亓發芝, 吳炅, 等. 乳腺癌改良根治術后一期乳房再造 [J]. 復旦學報(醫學版), 2004; 31(4): 434435.
4.	Neyt MJ, Blondeel PN, Morrison CM, et al. Comparing the cost of delayed and immediate autologous breast reconstruction in Belgium [J]. Br J Plast Surg, 2005; 58(4): 493497.
5.	AlGhazal SK, Sully L, Fallowfield L, et al. The psychological impact of immediate rather than delayed breast reconstruction [J]. Eur J Surg Oncol, 2000; 26(1): 1719.
6.	Mortenson MM, Schneider PD, Khatri VP, et al. Immediate breast reconstruction after mastectomy increases wound complications: however, initiation of adjuvant chemotherapy is not delayed [J]. Arch Surg, 2004; 139(9): 988991.
7.	Wilson CR, Brown IM, WeillerMithoff E, et al. Immediate breast reconstruction does not lead to a delay in the delivery of adjuvant chemotherapy [J]. Eur J Surg Oncol, 2004; 30(6): 624627.
8.	韓久卉, 張英澤. 乳房切除后乳房再造的意義及現狀 [J]. 中華整形外科雜志, 2004; 20(6): 468471.
9.	茍揚, 任國勝, 厲紅元. 規范化保乳手術在乳腺癌治療中的應用 [J]. 中國普外基礎與臨床雜志, 2009; 16(1): 7780.
10.	Borger J, Kemperman H, Hart A, et al. Risk factors in breastconservation therapy [J]. J Clin Oncol, 1994; 12(4): 653660.
11.	Chagpar A, Langstein HN, Kronowitz SJ, et al. Treatment and outcome of patients with chest wall recurrence after mastectomy and breast reconstruction [J]. Am J Surg, 2004; 187(2): 164169.
12.	Langstein HN, Cheng MH, Singletary SE, et al. Breast cancer recurrence after immediate reconstruction: patterns and significance [J]. Plast Reconstr Surg, 2003; 111(2): 712722.
13.	Murphy RX Jr, Wahhab S, Rovito PF, et al. Impact of immediate reconstruction on the local recurrence of breast cancer after mastectomy [J]. Ann Plast Surg, 2003; 50(4): 333338.
14.	邵志敏, 余科達. 乳腺外科的發展趨勢 [J]. 中國普外基礎與臨床雜志, 2007; 14(3): 252254.
15.	Downes KJ, Glatt BS, Kanchwala SK, et al. Skinsparing mastectomy and immediate reconstruction is an acceptable treatment option for patients with highrisk breast carcinoma [J]. Cancer, 2005; 103(5): 906913.
16.	Hill O, White K. Exploring women’s experiences of TRAM flap breast reconstruction after mastectomy for breast cancer [J]. Oncol Nurs Forum, 2008; 35(1): 8188.
17.	Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy [J]. Lancet, 1983; 1(8322): 459462.
18.	鄒天寧, 湯學良, 陳德滇, 等. 乳腺癌術后即刻乳房修復和重建的臨床研究 [J]. 中國癌癥雜志, 2009; 19(8): 644646.
19.	Sternberg EG, Perdikis G, McLaughlin SA, et al. Latissimus dorsi flap remains an excellent choice for breast reconstruction [J]. Ann Plast Surg, 2006; 56(1): 3135.
20.	亓發芝, 陳君雪, 狄根紅, 等. 擴大背闊肌肌皮瓣乳房再造 [J/CD]. 中華乳腺病雜志（電子版）, 2007; 1(6): 210213.
21.	康驊, 海濤, 蔡偉, 等. 擴大背闊肌肌皮瓣在乳腺癌即刻乳房再造中的應用 [J]. 首都醫科大學學報, 2007; 28(1): 2325.
22.	Soong IS, Yau TK, Ho CM, et al. Postmastectomy radiotherapy after immediate autologous breast reconstruction in primary treatment of breast cancers [J]. Clin Oncol (R Coll Radiol), 2004; 16(4): 283289.
23.	Delay E, Gounot N, Bouillot A, et al. Autologous latissimus breast reconstruction: a 3year clinical experience with 100 patients [J]. Plastic Reconstr Surg, 1998; 102(5): 14611478.
24.	徐華, 董佳生, 王露萍, 等. 乳房再造計算機輔助設計系統的開發和臨床應用 [J]. 組織工程與重建外科雜志, 2008; 4(2): 9496.
25.	牛兆河, 欒杰, 穆大力, 等. 背闊肌肌皮瓣乳房再造術后腋前皺襞的重建 [J]. 中國美容醫學, 2007; 16(3): 319321.

1. 郭娜, 倪毅, 關煒. 乳房再造術的研究進展 [J]. 山西中醫學院學報, 2008; 9(1): 6062.
2. 尹健, 張學慧, 張斌. 即刻乳房再造與延期乳房再造的心理調查 [J]. 中華整形外科雜志, 2005; 21(3): 175177.
3. 狄根紅, 亓發芝, 吳炅, 等. 乳腺癌改良根治術后一期乳房再造 [J]. 復旦學報(醫學版), 2004; 31(4): 434435.
4. Neyt MJ, Blondeel PN, Morrison CM, et al. Comparing the cost of delayed and immediate autologous breast reconstruction in Belgium [J]. Br J Plast Surg, 2005; 58(4): 493497.
5. AlGhazal SK, Sully L, Fallowfield L, et al. The psychological impact of immediate rather than delayed breast reconstruction [J]. Eur J Surg Oncol, 2000; 26(1): 1719.
6. Mortenson MM, Schneider PD, Khatri VP, et al. Immediate breast reconstruction after mastectomy increases wound complications: however, initiation of adjuvant chemotherapy is not delayed [J]. Arch Surg, 2004; 139(9): 988991.
7. Wilson CR, Brown IM, WeillerMithoff E, et al. Immediate breast reconstruction does not lead to a delay in the delivery of adjuvant chemotherapy [J]. Eur J Surg Oncol, 2004; 30(6): 624627.
8. 韓久卉, 張英澤. 乳房切除后乳房再造的意義及現狀 [J]. 中華整形外科雜志, 2004; 20(6): 468471.
9. 茍揚, 任國勝, 厲紅元. 規范化保乳手術在乳腺癌治療中的應用 [J]. 中國普外基礎與臨床雜志, 2009; 16(1): 7780.
10. Borger J, Kemperman H, Hart A, et al. Risk factors in breastconservation therapy [J]. J Clin Oncol, 1994; 12(4): 653660.
11. Chagpar A, Langstein HN, Kronowitz SJ, et al. Treatment and outcome of patients with chest wall recurrence after mastectomy and breast reconstruction [J]. Am J Surg, 2004; 187(2): 164169.
12. Langstein HN, Cheng MH, Singletary SE, et al. Breast cancer recurrence after immediate reconstruction: patterns and significance [J]. Plast Reconstr Surg, 2003; 111(2): 712722.
13. Murphy RX Jr, Wahhab S, Rovito PF, et al. Impact of immediate reconstruction on the local recurrence of breast cancer after mastectomy [J]. Ann Plast Surg, 2003; 50(4): 333338.
14. 邵志敏, 余科達. 乳腺外科的發展趨勢 [J]. 中國普外基礎與臨床雜志, 2007; 14(3): 252254.
15. Downes KJ, Glatt BS, Kanchwala SK, et al. Skinsparing mastectomy and immediate reconstruction is an acceptable treatment option for patients with highrisk breast carcinoma [J]. Cancer, 2005; 103(5): 906913.
16. Hill O, White K. Exploring women’s experiences of TRAM flap breast reconstruction after mastectomy for breast cancer [J]. Oncol Nurs Forum, 2008; 35(1): 8188.
17. Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy [J]. Lancet, 1983; 1(8322): 459462.
18. 鄒天寧, 湯學良, 陳德滇, 等. 乳腺癌術后即刻乳房修復和重建的臨床研究 [J]. 中國癌癥雜志, 2009; 19(8): 644646.
19. Sternberg EG, Perdikis G, McLaughlin SA, et al. Latissimus dorsi flap remains an excellent choice for breast reconstruction [J]. Ann Plast Surg, 2006; 56(1): 3135.
20. 亓發芝, 陳君雪, 狄根紅, 等. 擴大背闊肌肌皮瓣乳房再造 [J/CD]. 中華乳腺病雜志（電子版）, 2007; 1(6): 210213.
21. 康驊, 海濤, 蔡偉, 等. 擴大背闊肌肌皮瓣在乳腺癌即刻乳房再造中的應用 [J]. 首都醫科大學學報, 2007; 28(1): 2325.
22. Soong IS, Yau TK, Ho CM, et al. Postmastectomy radiotherapy after immediate autologous breast reconstruction in primary treatment of breast cancers [J]. Clin Oncol (R Coll Radiol), 2004; 16(4): 283289.
23. Delay E, Gounot N, Bouillot A, et al. Autologous latissimus breast reconstruction: a 3year clinical experience with 100 patients [J]. Plastic Reconstr Surg, 1998; 102(5): 14611478.
24. 徐華, 董佳生, 王露萍, 等. 乳房再造計算機輔助設計系統的開發和臨床應用 [J]. 組織工程與重建外科雜志, 2008; 4(2): 9496.
25. 牛兆河, 欒杰, 穆大力, 等. 背闊肌肌皮瓣乳房再造術后腋前皺襞的重建 [J]. 中國美容醫學, 2007; 16(3): 319321.

《中國普外基礎與臨床雜志》

擴大背闊肌肌皮瓣在乳腺癌改良根治術后一期乳房再造中的應用

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《中國普外基礎與臨床雜志》

擴大背闊肌肌皮瓣在乳腺癌改良根治術后一期乳房再造中的應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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