保留皮肤的乳腺癌改良根治术后即时乳房再造

目的；介绍保留皮肤的乳腺癌改良根治术后即时乳房再造的经验。方法；对早期乳腺癌，保留乳房皮肤，切除乳腺组织和腋窝淋巴结，应用下腹部横行腹直肌肌皮瓣或扩大背阔肌肌皮瓣即时乳房再造。结果：应用该方法治疗37例，再造乳房形态良好。结论：保留皮肤乳腺癌根治术后即时乳房再造，即口隐蔽，再造乳房形态效果好，对早期乳腺癌患者值得推广应用。     

保留皮肤的乳腺癌改良根治术后一期乳房假体再造

目的探讨用硅胶假体植入法修复乳腺癌改良根治术后乳房缺失的疗效。方法2005年6月至11月,10例患者行保留皮肤的乳腺癌改良根治术后,同期于胸大肌后植入硅胶假体再造乳房,并根据冰冻结果决定是否保留乳头乳晕复合体。结果本组病人术后无伤口积液感染,皮肤坏死及异物反应等。10例患者美观效果均满意,其中有4例保留乳头乳晕复合体。所有病人进行术后随访。随访时间为1～6个月。未发现有远处转移和局部复发。无上肢水肿及功能障碍。结论保留皮肤的乳腺癌改良根治术后用硅胶假体行一期乳房再造,具有创伤小、安全、简单、恢复快的特点;再造后乳房美观,效果满意。     

保留皮肤的乳腺癌改良根治术后即时乳房再造

目的　介绍保留皮肤的乳腺癌改良根治术后即时乳房再造的经验。方法　对早期乳腺癌 ,保留乳房皮肤 ,切除乳腺组织和腋窝淋巴结 ,应用下腹部横行腹直肌肌皮瓣或扩大背阔肌肌皮瓣即时乳房再造。结果　应用该方法治疗 37例 ,再造乳房形态良好。结论　保留皮肤乳腺癌根治术后即时乳房再造 ,切口隐蔽 ,再造乳房形态效果好 ,对早期乳腺癌患者值得推广应用     

保留皮肤的乳腺癌改良根治术后即时乳房再造

目的介绍保留皮肤的乳腺癌改良根治术后即时乳房再造的经验.方法对早期乳腺癌,保留乳房皮肤,切除乳腺组织和腋窝淋巴结,应用下腹部横行腹直肌肌皮瓣或扩大背阔肌肌皮瓣即时乳房再造.结果应用该方法治疗37例,再造乳房形态良好.结论保留皮肤乳腺癌根治术后即时乳房再造,切口隐蔽,再造乳房形态效果好,对早期乳腺癌患者值得推广应用.     

乳腺癌改良根治术后即刻乳房再造46例分析

目的 探讨乳腺癌改良根治术后即刻乳房再造的方法 和疗效.方法 自2007年1月至2010年1月,对46例单侧乳腺癌改良根治术后患者采取即刻背阔肌皮瓣联合硅凝胶假体置入乳房再造术.结果 所有患者的切口均愈合良好,转移皮瓣全部成活,其中有2例背部积液,2例乳头乳晕部分坏死.经6个月至3年随访,全部患者无肿瘤局部复发或远处转移,再造乳房无包膜挛缩,外形满意.结论 乳腺癌改良根治术后即刻乳房再造操作简单易行,效果明显,安全性高,成活率高,外形良好,提高了乳腺癌患者术后的生活质量,值得临床应用.     

乳腺癌改良根治术后应用带蒂背阔肌皮瓣移植一期乳房再造

目的：介绍应用带蒂背阔肌皮瓣移植进行乳腺癌改良根治术后一期乳房再造的方法与疗效。方法：自2000年，用带蒂背阔肌皮瓣移植方法对中青年妇女乳腺癌改良根治术后行一期乳房再造20例。结果：全部病例的肌皮瓣及其中4例同时保留乳头病例的乳头均存活，无积液、感染、坏死等并发症，再造乳房外形美观。结论：用带蒂背阔肌皮瓣移植行乳腺癌术后一期乳房再造是乳腺癌改良根治术后恢复乳房外形的一种理想方法。     

乳腺癌改良根治术后Ⅰ、Ⅱ期乳房再造的临床研究

目的：探讨乳腺癌改良根治术后上蒂横行腹直肌肌皮瓣(TRAM)乳房、乳头乳晕再造的方法、效果及可行性。方法：本组对17例Ⅰ、Ⅱ期乳腺癌患，在行改良根治术的同时或术后应用TRAM皮瓣再造乳房，其中10例同期行乳头乳晕再造。结果：随访3～26月，再造乳房形态良好，仅1例部分皮肤血运欠佳。结论：此术式既达到了治疗的目的，又弥补了因乳房缺失而带来的心理压力和形体缺陷，值得推广。     

保留乳头乳晕的乳腺癌改良根治术后即刻假体乳房再造的效果

目的:探讨硅胶假体在保留乳头乳晕的乳腺癌改良根治术后即刻乳房再造的效果。方法:2016年1月至2018年1月,湖南省郴州市第一人民医院乳腺甲状腺外科收治30例女性乳腺癌患者,年龄30~55岁,平均42岁;分为两组。观察组15例采用保留乳头乳晕的乳腺癌改良根治术联合即刻假体乳房再造,对照组15例仅行乳腺癌改良根治术。比较...     

乳腺癌术后即时乳房再造

1990年3月至1994年3月,为7例乳腺癌术后用国产硅胶囊乳房假体充填进行即时乳房再造,均获成功,无手术并发症。经3个月至4年随访,手感柔软,双乳基本对称。对即时再造术的适应证、方法、时间的选择和注意事项进行了讨论。     

保留皮肤的乳腺癌改良根治术后即刻乳房假体再造的临床应用

目的探讨保留皮肤的乳腺癌改良根治术后即刻乳房假体再造的临床应用价值。方法我院2006年1月至2009年12月期间收治的28例乳腺癌患者行保留皮肤的乳腺癌改良根治术后,同时于胸大肌后置入硅胶假体再造乳房,对围手术期结果、乳房外观评价以及随访结果进行分析。结果本组28例患者均行腋窝淋巴结清扫术,清除淋巴结数目为14~32枚,中位数为21枚。手术时间为117~140 min(平均126 min),术中出血量为82~124 ml(平均98 ml),术后引流管拔除时间为3~5 d。所有患者术后均无伤口积液、感染、皮肤坏死、异物反应等,22例保留了乳头乳晕复合体的患者均无乳头乳晕缺血、坏死。患者术后乳房外观评价中,10例为优,18例为良,优良率为100%。所有患者术后均获随访,随访时间为12~48个月(中位随访时间24个月),未发现有远处转移和局部复发,无上肢水肿及功能障碍。所有患者乳房外观及手感满意,无纤维包膜挛缩。结论保留皮肤的乳腺癌改良根治术后用硅胶假体行即刻乳房再造具有创伤小、安全、手术操作简单、术后恢复快的特点,再造后乳房美观,效果满意,值得临床推广。     

乳腺癌保留皮肤改良根治并即刻假体再造与传统改良根治术的疗效比较

目的 比较乳腺癌保留皮肤改良根治并即刻假体再造和传统改良根治术的治疗效果.方法 对2004年1月至2008年12月手术治疗的530例0～Ⅲa期女性乳腺癌患者病例资料进行回顾性分析.530例中,91例行乳腺癌保留皮肤改良根治并即刻假体再造,439例行传统改良根治术.通过比较两组患者术后并发症、局部复发率、远处转移率、病死率的差异,评价乳腺癌保留皮肤改良根治并即刻假体重建与传统改良根治术的疗效.结果 即刻假体再造组随访患者84例,中位随访时间35个月,局部复发率2.4%,远处转移率8.3%,病死率6.0%;改良根治组随访患者439例,中位随访时间36个月,局部复发率3.3%,远处转移率9.5%,病死率6.5%.随访期间两组复发率、转移率、病死率的差异均无统计学意义(P＞0.05).即刻假体再造组术后美观效果随访12个月,医生和患者评估的良好率分别为93%、87%.结论 乳腺癌保留皮肤改良根治并即刻假体再造可以达到和传统改良根治术相当的疗效,并可显著改善患者术后乳房外形美观及生活质量.

Abstract：

Objective To compare the therapy efficiency of immediate implanting breast reconstruction after skin sparing mastectomy and modified radical mastectomy in breast cancer. Methods The data of 530 female patients with early of stage 0 to Ⅲ a breast cancer was retrospectively analyzed, from January 2004 to Decembet 2008. Among the patients,91 patients operated with skin sparing mastectomy and immediate implanting breast reconstruction ( Group of immediate implanting reconstruction), and 439 patients were with modified radical mastectomy (Group of modified radical mastectomy ). By comparing complications, local recurrence, distant metastases and mortality rates between the two groups, the research was done to evaluate the therapy efficiency. Results In the group of immediate implanting reconstruction,84 patients completed follow-up with the median follow-up time of 35 months ( 14-72 months) while the local recurring rate was 2. 4%, distant metastasis rate was 8. 3% and mortality rate was 6. 0%. In the group of modified radical mastectomy, 398 patients completed follow-up with the median follow-up time of 36 months ( 12-74 months) while the local recurring rate was 3.3%, distant metastasis rate was 9. 5% and mortality rate was 6. 5%. Therefore there was no obvious statistic difference between the two groups in local recurring rate, distant metastasis rate and mortality rate (P ＞ 0. 05 ). Evaluation of aesthetic results was done in the 84 patients after immediate implanting reconstruction for 12 months which was 93% as good or excellent by surgeons while 87% by patients. Surgeons and patients were both satisfied with the breast appearance. Conclusions For patients with early stage breast cancer, combining standard postoperative therapy, skin sparing mastectomy and immediate implanting reconstruction could achieve the same effect as the traditional modified radical mastectomy, while reconstruction would bring about better appearance and higher quality of life.     

乳腺癌手术切口与再造术时机的选择

目的为消除根治手术对乳腺癌患者所带来的形体破坏和巨大的心理压力，改善患者的心理、生理状况及生活质量，探求一种既能达到根治目的，又能减轻对形体的破坏，尽快恢复乳房外形美观的手术方式。方法根据肿瘤所在部位和分期，选择横切口乳癌根治术，及肿瘤外3cm范围的局部切除加腋下纵切口淋巴清扫术．以及背阔肌皮瓣即时乳房再造术。结果54例患者中，背阔肌皮瓣即时再造18例，1例因脂肪液化皮瓣坏死，17例乳房再造成功；横切口乳癌改良根治术36例，在放射治疗后6周至2年，陆续有9例患者采用背阔肌皮瓣法或下腹横行岛状腹直肌肌皮瓣法行Ⅱ期乳房再造。随访3个月至5年，除1例1年后出现对侧乳房及骨转移外．其余均无肿瘤生长。结论此两种术式不仅达到了乳癌根治的目的，还最大程度地减少了皮瓣坏死的并发症和乳房缺如带给患者的心理压力．而且手术安全可靠．     

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目的　介绍乳腺癌改良根治术同期应用自体组织及硅凝胶假体植入行乳房再造的经验。方法　自2 0 0 2年 2月至 2 0 0 4年 10月 ,对 32例乳腺癌行改良根治术 ,同时应用自体组织 (胸小肌及背阔肌瓣 )和 (或 )硅凝胶假体植入行乳房再造。结果　应用该方法治疗 ,均获成功 ,无手术并发症。再造乳房形态良好。结论　乳腺癌改良根治术同期乳房再造 ,满足肿瘤治疗和形体美容两方面要求 ,提高病人生存质量 ,值得推广。     

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目的用安全、简便的方法解决乳腺癌根治术后乳房缺损问题。方法2002年4月至2004年9月,在行保留皮肤的乳腺癌改良根治术后同期于胸大肌后植入Meter或Beck假体,即时再造乳房。根治术时根据冰冻结果决定是否保留乳头乳晕复合体。结果32例病人中,23例行Meter单囊假体植入,9例行Beck双囊可扩张假体植入,5例保留乳头乳晕复合体,均获得满意效果。32例病人中经病理证实15例为浸润性导管癌,11例为浸润性小叶癌,4例为浸润性导管癌同时合并浸润性小叶癌,1例为乳管内乳头状瘤病伴部分癌变,1例为浸润性小叶癌保乳术后复发。结论保留皮肤的乳腺癌改良根治术后运用假体植入法行Ⅰ期乳房再造,创伤小、安全、快速,恢复期短,手术操作简单易行,即时效果满意。     

保乳手术与改良根治术治疗乳腺癌的体会

【摘要】 目的 探讨保乳手术与改良根治术治疗乳腺癌的临床效果。方法 对我院从2005年1月到2007年6月期间乳腺癌治疗的临床资料进行回顾性分析。选择60名经手术治疗的乳腺癌患者,分为观察组和对照组,每组各30例,对照组给予改良根治术治疗,观察组给予保乳手术治疗,随访5年观察临床效果。 结果 观察组患者在手术时间、住院时间、术中出血量及并发症发生率方面明显优于对照组(P<0.05)。两组5年生存率比较差异无统计学意义(P>0.05)。结论 保乳手术治疗乳腺癌的效果确切,优点多,临床医师应根据患者的适应证合理应用。     

Synchronous elective contralateral mastectomy and immediate bilateral breast reconstruction in women with early-stage breast cancer

Background: The role of elective contralateral mastectomy (ECM) in women with early-stage breast cancer who elect or require an ipsilateral mastectomy and desire immediate bilateral breast reconstruction (IBR) is an intellectual and emotional dilemma for both patient and physician. In an attempt to clarify the rationale for this approach, we reviewed our experience with ECM and IBR and evaluated operative morbidity, the incidence of occult contralateral breast cancer, and patterns of recurrence. Patients and Methods: We retrospectively reviewed the records of 155 patients with primary unilateral breast cancer (stage 0, I, or II) and negative findings on physical and mammographic examinations of the contralateral breast who underwent ipsilateral mastectomy and simultaneous ECM with IBR between 1987 and 1995. Results: The median age of the patients was 46 years (range, 25 to 69 years). Clinical stage at diagnosis was stage 0, I, and II in 19.4%, 54.2%, and 26.4% of patients, respectively. Factors likely to influence the use of ECM were family history of breast cancer in first-degree relatives (30%), any family history of breast cancer (56%), difficulty anticipated in contralateral breast surveillance (48%), associated lobular carcinoma in situ (23%), multicentric primary tumor (28%), significant reconstructive issues (14%), and failure of mammographic identification of the primary tumor (16%). Skin-sparing mastectomies were performed in 81% of patients. Overall, 70% of patients underwent reconstruction using autogenous tissue transfer. Reoperations for suspected anastomotic thrombosis were performed in seven patients. Two patients experienced significant partial or complete flap loss. Histopathologic findings in the ECM specimen were as follows: benign, 80% of patients; atypical ductal hyperplasia, 12% of patients; lobular carcinoma in situ, 6.5% of patients; ductal carcinoma in situ, 2.7% of patients; and invasive carcinoma, 1.3% of patients. Eighteen patients (12%) had evidence of locoregional or distant recurrences, with a median follow-up of 3 years. In one patient (0.6%), invasive ductal carcinoma developed on the side of the elective mastectomy. Conclusions: The use of ECM and IBR cannot be justified if the only oncologic criterion considered is the incidence of occult synchronous contralateral disease. However, in a highly selected population of young patients with a difficult clinical or mammographic examination and an increased lifetime risk of developing a second primary tumor, ECM and IBR is a safe approach. Presented at the 50th Annual Meeting of the Society of Surgical Oncology, Chicago, Illinois, March 1997.     

乳腺癌“逆行”改良根治术的近期疗效评价

目的：评价乳腺癌逆行改良根治术的近期疗效。方法：将80例先清扫腋窝淋巴结再行乳腺切除的乳腺癌逆行改良根治术与84例传统改良根治术作比较,通过收集临床资料及术后随访评价两者的疗效。结果：改良根治术与逆行改良根治术两组病人平均手术时间分别为121.43min和120.63min,平均术后住院时间分别为7.49d和7.75d,平均术后引流管拔除时间分别为5.12d和5.00d,腋窝淋巴结清扫数量分别为25.49个和24.71个,病理证实淋巴结转移比例分别为42.86%和46.25%。病人术后伤口引流量,第1天改良根治术组平均引流量为168mL（50～300mL）,逆行改良根治术组平均引流量为144mL（50～250mL）,两组比较有显著性差异（P=0.013）。而两组术后随访并发症无统计学差异。结论：乳腺癌逆行改良根治术是在乳腺癌改良根治术基础上创新的一种手术方法,符合肿瘤手术学原理,在不增加手术难度的同时安全且未增加近期术后并发症。