乳腺癌术后即刻乳房重建的适应证及手术方法的选择

近年来,各种乳腺疾病特别是乳腺癌的发病率逐年增高,是女性最常见的恶性肿瘤。乳房不仅是哺乳器官,也是体现女性形象美的重要因素。传统的乳腺癌根治手术,使患者胸壁严重毁损、乳房缺失、腋窝凹陷、姿势变形等,彻底摧毁了女性优美的性征和曲线美,随着生存期的延长,对于大多数术后患者,癌的威胁会逐步破乳房畸形、缺失所引起的烦恼与痛苦所替代,乳腺癌患者需要面对更大更复杂的心理压力,乳房重建已成为乳腺癌患者术后的迫切需要。随着对乳腺癌诊断技术的不断提高,早期乳腺癌的诊断率也在提升,在肿瘤根治的同时,     

乳腺癌术后即刻假体植入乳房重建

目的探讨保留皮肤的乳腺癌改良根治术后即刻乳房重建的手术技巧及术后并发症的防治处理方法。方法26例乳腺癌女姓患者实施了改良根治术＋即刻假体植入乳房重建术,术后跟踪按摩并进行必要的辅助治疗。结果术后患者的乳腺癌得到根治,同时乳房达到形体美容的功效,大大减少了患者的心理障碍,提高了患者术后的生活质量。结论乳腺癌术后即刻假体植入乳房再造术易被广大医生及患者所接受。     

乳腺癌术后即刻乳房重建肿瘤安全性探讨

即刻乳房重建在避免病人接受二次手术的同时，可以减轻病人失去乳房的心理创伤。但是，肿瘤外科医生在选择即刻乳房重建时必须保证肿瘤的安全性，术前细致的评估、术中足够完整的腺体切除是保证肿瘤安全性的前提。美国国家综合癌症网络（NCCN）指南明确指出，炎性乳腺癌是即刻乳房重建的禁忌证，此外，对于拟行术后放疗的病人也需慎重选择即刻乳房重建；尽管缺乏高级别循证医学证据，但现有的数据显示，即刻乳房重建并不影响术后辅助化疗的疗效，部分病人选择保留乳头乳晕的皮下腺体切除是安全可靠的，假体植入术后的淋巴瘤虽有报道，但发病率很低。因此，乳房切除术后即刻乳房重建在适宜的乳腺癌病人中是安全可靠的手术方式。     

乳腺癌术后乳房重建时机及术式选择

结合整形外科的理念和手段，在保证肿瘤安全性的前提下对乳腺癌病人进行乳房重建修复，成为乳腺外科领域重要的发展方向。乳房重建可以与全乳切除或部分乳房切除术同时进行，也可以延迟至完成辅助治疗后的适当时间进行，前者称为即刻乳房重建，后者称为延期乳房重建。临床上根据病人的疾病情况和自身的需求来确定重建时机。部分病人采用延迟-即刻乳房重建来降低辅助放疗给重建带来的不利影响，减少术后严重并发症的发生。从重建的技术手段来看，乳房重建有自体皮瓣乳房重建、假体乳房重建以及自体联合假体的乳房重建。植入物重建是即刻乳房重建中最常用的术式。在延期乳房重建中，更常采用自体皮瓣乳房重建或两步法的植入物重建术。     

即刻及延期乳房再造方法的选择

目的回顾总结乳腺癌根治术后应用单纯假体植入、Becker可扩张假体植入和单蒂腹部横形腹直肌肌皮瓣（TRAM）移植、扩大背阔肌肌皮瓣（ELDF）移植乳房再造术的经验,探讨手术的适应证、方法和效果。方法自2002年7月至2005年10月,共67例患者进行了乳腺癌根治术后乳房再造术。即刻乳房再造56例：单纯假体植入38例、Becker可扩张假体植入16例、单蒂TRAM移植2例。延期乳房再造11例：单蒂TRAM移植6例、ELDF移植4例、Becker可扩张假体植入1例。结果手术效果满意,优良率超过90％。5例患者出现轻微并发症：皮瓣局灶性坏死2例,保留的乳头乳晕部分坏死1例,血清肿2例。结论单纯假体植入用于即刻乳房再造,适用于乳房较小、行保留皮肤的乳腺癌根治术后的患者,不宜用于延期乳房再造;可扩张假体植入即刻乳房再造适用于乳房较大或改良乳腺癌根治术的患者,同时可扩张假体植入延期乳房再造可用于皮肤、肌肉保留较好的乳腺癌根治患者;TRAM和ELDF皮瓣移植乳房再造是自体组织移植,其安全性高,可用于即刻和延期乳房再造。     

不同分期乳腺癌术后即刻乳房重建的新思考

乳腺癌作为女性最常见的恶性肿瘤,在全球范围内仍是一个重大公共卫生问题。随着患者对生活质量要求的提高与生存率的提升,越来越多的患者倾向于选择乳腺癌术后即刻乳房重建（immediate breast reconstruction, IBR）,有利于改善患者的心理健康和生活质量,也加快了重建技术的不断创新。然而国内外对不同分...     

乳房缩小术的并发症分析及适应证选择

目的：为预防乳房缩小术后并发症以及为临床选择手术适应证提供依据。方法：结合乳房美学、临床特征对乳房缩小术早期、晚期并发症进行分析。结果：早期并发症为血肿,乳头乳晕坏死,切口裂开、感染,乳汁瘘等;晚期并发症为增生疤痕,乳房塑形不满意,乳头乳晕变形,心理上不平衡。结论：针对不同程度的乳房肥大下垂特征、临床表现及不同年龄,提出手术绝对和相对适应证。     

乳腺癌术后乳房即刻再造

随着乳腺癌诊治水平的不断进步及患者对生活质量要求的日益提高，即刻乳房再造已越来越广泛地应用于乳腺癌的治疗，不仅显著提高了患者的生活质量，同时也成为乳腺癌综合治疗的一个重要部分。本文对乳腺癌术后乳房即刻再造的方法及相关研究进展做一综述。     

单纯乳腺切除后的乳房重建

作者对单纯乳腺切除术后及时施行乳房重建是值得推崇的,然其报告的方法容量不足。欲取得比较满意的整形效果,在切除乳腺后,应有足够量的组织作为充填材料,或/和应用硅胶囊假体植入加以隆起,使再造的乳房外形丰满。     

即刻乳房重建的治疗现状

乳腺癌的治疗已经从根治性手术治疗发展到了现今的保乳治疗。对于不适于或不愿接受保乳治疗的患者,根治术加乳房重建也能达到类似的效果。本文将从即刻乳房重建的安全性和适应证、重建手术方式的选择、重建后的修复和乳头乳晕重建等方面进行综述。     

乳腺癌术后肌皮瓣重建术44例分析

目的:探讨乳腺癌术后一期乳房重建不同术式的疗效对比。方法:回顾分析本院2005年1月至2007年12月乳腺癌术后一期乳房再造44例。其中一期行背阔肌肌皮瓣移植者27例,横向腹直肌肌皮瓣移植者17例。结果:中位随访时间22.5个月,两种重建方式在客观效果评价、术后并发症和复发率方面均无统计学差异,但腹直肌肌皮瓣组的主观效果评价优于背阔肌肌皮瓣组(P=0.0462)。结论:背阔肌肌皮瓣和腹直肌肌皮瓣移植仍是目前乳房重建的常用术式。而腹直肌肌皮瓣重建与背阔肌皮瓣相比具有一定的优势。     

Immediate breast reconstruction after mastectomy for cancer

BACKGROUND: Immediate breast reconstruction after mastectomy has increased over the past decade following the unequivocal demonstration of its oncological safety and the availability of reliable methods of reconstruction. Broadly, it is undertaken in the treatment of breast cancer, after prophylactic mastectomy in high-risk patients, and in the management of treatment failure after breast-conserving surgery and radiotherapy. Immediate breast reconstruction can be achieved reliably with a variety of autogenous tissue techniques or prosthetic devices. Careful discussion and evaluation remain vital in choosing the correct technique for the individual patient. METHODS: This review is based primarily on an English language Medline search with secondary references obtained from key articles. RESULTS AND CONCLUSION: Immediate breast reconstruction is a safe and acceptable procedure after mastectomy for cancer; there is no evidence that it has untoward oncological consequences. In the appropriate patient it can be achieved effectively with either prosthetic or autogenous tissue reconstruction. Patient selection is important in order to optimize results, minimize complications and improve quality of life, while simultaneously treating the malignancy. Close cooperation and collaboration between the oncological breast and reconstructive surgeons is desirable in order to achieve these objectives.     

Immediate autologous latissimus breast reconstruction after skin sparing mastectomy

A technique of immediate breast reconstruction, combining skin sparing mastectomy and autologous latissimus breast reconstruction, is presented. In this study, 50 patients underwent this procedure between May 1993 and May 1997. The most frequent indication (62%) was ductal carcinoma in situ (multifocal, high grade or larger than 3 cm). In 38% of cases, the patients had a contraindication to the TRAM flap; in the other cases (62%) the patients preferred the dorsal donor site to the abdominal site. Reduction of the contralateral breast was done in 20% of cases of unilateral reconstruction. The aesthetic results, evaluated by two others surgeons, were rated as very good in 88% of cases, good in 8% and poor in 4%. Study of patient satisfaction showed 84% of patients to be pleased, 12% satisfied and 4% poorly satisfied. Dorsal sequelae were rated as slight in 96% of cases, intermediate in 4% and marked in none. The main disadvantage was dorsal seroma which occurred in 62% of cases but was easily managed by repeated aspiration. No patient developed a local recurrence or distant metastases. This technique represents a significant advance in breast reconstruction, giving a breast of natural shape and consistency with no transverse scar or patch effect due to the flap. Received: 13 October 1997 / Accepted: 16 November 1998     

Immediate breast reconstruction after modified mastectomy for carcinoma of the breast

With the increased knowledge of breast cancer and its implications, many women are unwilling to accept the deformity that results from the surgical treatment of this disease. The acceptance of modified mastectomy as the procedure of choice in carcinoma of the breast has resulted in selected patients being offered rehabilitation by restoration of the breast contour at the time of definitive surgery or 6 months later. We believe that an immediate breast prosthesis after modified mastectomy for carcinoma of the breast is an acceptable procedure in selected patients. The two-team approach to this procedure as advocated by Halsted will provide the patient with a maximal cancer preventive operation with a minimum of mental and emotional anxiety.     

Immediate reconstruction after subcutaneous mastectomy

We describe an improved technique for subcutaneous mastectomy using two surgical approaches, one through a short axillary incision and the other through an inframmary incision. Pathological breast tissue is removed from the prepectoral space through the lower incision and a silicone implant is placed in the retropectoral space through the axillary approach. A further modification is described using a laterally rotated inframammary dermis flap to reinforce the lateral margin of the retropectoral space containing the prosthesis.     

乳腺癌改良根治一期乳房再造术后近期并发症的探讨

目的:探讨乳腺癌根治一期乳房再造术后近期发生的并发症及其原因.方法:收集本院2006年2月～2007年12月32例乳腺癌改良根治一期乳房再造病例.全组病例行乳房改良根治术乳房再造方法:一期行单蒂下腹部横行腹直肌肌皮瓣(TRAM)移植术3例,背阔肌肌皮瓣移植和假体植入6例,单纯假体植入术12例,乳房扩张假体植入术11例.结果:中位随访时间14个月,1例乳房局部血肿,1例术后10个月发生腹部切口疝:边缘局部坏死7例,乳头乳晕发生部分坏死2例,其中1例皮瓣坏死范围大导致假体露出.并发症的总发生率34.4%(11/32).结论:乳腺癌行改良根治性手术一期乳房再造术后并发症发发生率较高.乳癌改良根治手术时,要注意皮瓣及乳头乳晕区切除的宽度和剥离皮瓣的厚度:移植皮瓣时要注意移植的肌肉组织血运是否完整和有无遗留的微小血管未结扎;乳房再造术仅植入扩张器者,因局部张力小,对皮瓣血运影响小,并发症发生率低.