牛心包补片在即刻假体乳房再造中应用

<正>1技术简介生物及合成材料作为自体组织的良好替代,已普遍使用于即刻乳房再造^[1]。在国际上,使用的补片主要包括生物来源的脱细胞补片及合成材料补片TiLoop^?。补片起到承托与固定假体的作用,其使用显著缩短了手术时间,避免了供区创伤,降低了包膜挛缩率^[2-3]。牛心包补片(艾瑞欧)是中国自主研发的脱细胞基质产品,是临床中使用的补片之一。     

组织扩张器在乳腺癌术后乳房重建中的应用现状

乳腺癌的治疗已经从传统的根治术发展到了现今的保乳及乳房重建治疗。假体置入在乳腺癌即刻乳房重建中得到广泛应用,但部分患者术后需行放射治疗,增加了假体包膜挛缩的发生率,同时二期乳房再造患者形成胸壁瘢痕组织,影响假体置入乳房再造效果。软组织扩张器的应用很好地解决了上述问题,作者就软组织扩张器在乳腺癌术后乳房重建中的应用现状进行综述。     

保留皮肤的乳腺癌改良根治术后即刻乳房再造的临床应用

目的探讨保留皮肤的乳腺癌改良根治术后即刻再造乳房的适应证、方法、效果及可行性。方法2002年1月至2007年11月本院对94例乳腺癌患者行保留乳房皮肤皮下乳腺组织切除加腋窝淋巴结清扫术后，应用下腹部横行腹直肌肌皮瓣（transverse rectus abdominis myocutaneous flap，TRAM）、背阔肌肌皮瓣（latissimus dorsi myocutaneous flap，LDM）联合或不联合假体、单纯乳房假体植入4种方式即刻再造乳房。结果再造手术均取得成功。带蒂TRAM再造47例，LDM再造共42例（其中联合假体28例），单纯乳房假体植入5例。4例出现轻微术后并发症（4．25％）。经过3～67个月随访，局部区域复发率为0，再造乳房形态自然，效果满意，术后外观评价优良率97．87％。结论合理选择病例行保留皮肤或保留乳头乳晕乳腺癌改良根治术后即刻乳房再造是安全可靠的，切口隐蔽并能够保留原有乳房皮肤的感觉，从而获得最佳美容效果，值得广泛推广和应用。     

乳腺癌改良根治术一期乳房重建（附5例报告）

文章报告５例早期乳腺癌患者在功能性改良根治的同时利用背阔肌肌皮瓣转位加硅胶囊假体充填一期乳房再造的临床资料。对乳腺癌术后乳房再造的适应症、再造时间及组织材料选择进行了讨论。提出了为再造手术的方便，根治的切口以斜横切口为好。     

假体植入在即刻乳房再造中的应用

目的探讨并分析保留皮肤乳腺切除术后应用Becker可扩张假体或Mentor光面假体植入即刻乳房再造的手术方法、效果及并发症。方法本组共96例，行保留皮肤的乳腺切除术后，再行Becker可扩张假体或Mentor光面假体植入即刻乳房再造，其中Mentor光面假体植入68例，可扩张假体植入28例。本组有30例患者保留乳头、乳晕。根据乳房的体积、形状、与对侧乳房的对称性比较及患者满意情况，评价手术效果。结果效果优29例，良47例，一般12例，差8例。并发症发生率为12．5％。结论假体植入即刻乳房再造安全可靠，手术效果好，并发症少，适用于早期乳腺癌患者。选择性保留乳头、乳晕并不增加局部复发的风险。手术成功的关键在于病例的选择，乳腺癌根治切口设计及术中、术后的处理。     

乳腺癌术后一期乳房再造

背景与目的：乳房再造使乳腺癌全乳切除患者重获完整的乳房外形。本文介绍乳腺癌术后应用带蒂背阔肌肌皮瓣联合或不联合假体和带蒂横向腹直肌肌皮瓣（TRAM）行一期乳房再造的经验，并探讨适合中国乳腺癌患者的乳房再造方式。方法：2000年1月-2005年7月，74例乳腺癌患者乳房切除后，应用背阔肌肌皮瓣或带蒂TRAM行一期乳房再造。结果：再造手术均取得成功，背阔肌肌皮瓣再造62例（83．8％），其中联合假体13例、带蒂TRAM再造12例、联合假体1例。经过2～66个月随访，局部区域复发率4．1％。患者满意度高，可接受度96％。而且这两种自体再造方式在是否需要联合假体上没有差别（P=0．440）。结论：乳腺癌术后一期乳房再造能同时满足肿瘤治疗和形体美容的要求，提高患者生活质量，背阔肌肌皮瓣再造对中国女性适用性好，值得推广。     

即刻乳房再造在乳腺癌手术中的应用与探讨

目的探讨即刻乳房再造在乳腺癌手术中的应用价值。方法自2005年10月至2009年2月共完成了26例乳腺癌改良根治即刻乳房再造手术,其中10例为局部晚期乳腺癌。即刻腹直肌肌皮瓣乳房再造术12例,背阔肌肌皮瓣乳房再造术8例,保留乳头乳晕复合体皮下乳腺全切假体植入乳房再造术5例,保留乳头乳晕复合体皮下乳腺全切背阔肌肌皮瓣结合假体植入乳房再造术1例。结果全组手术切缘病理均达到阴性,皮瓣全部成活,无假体相关并发症,亦无腹壁疝发生。再造乳房形态满意,肌皮瓣再造乳房可以安全地耐受术后放疗,随访1～40个月无局部复发病例。结论即刻乳房再造手术从根本上改善了乳腺癌患者术后的生活质量,在局部晚期乳腺癌手术中,肌皮瓣乳房再造还可以为足够的切除范围提供安全保障,颇具临床应用价值。     

乳腺癌切除即刻乳房再造术中假体的选择

目的: 研究乳腺癌切除即刻乳房再造术中选择假体的方法,探讨即刻假体乳房再造的适应证。 方法: 收集2007年6月至2012年6月南昌市第三医院乳腺肿瘤科的乳腺癌切除术患者121例,其中乳腺癌改良根治术32例、单纯乳腺切除术89例。乳腺切除后根据阿基米德法计算缺失乳房体积,并测量切除组织直径,以切除组织的体积和直径为依据选择乳房假体,并置入胸大肌及前锯肌后间隙。 结果: 术后随访6~72个月,术后无假体外露、皮瓣坏死以及感染等并发症,出现血清肿4例。对患者行手术效果满意度问卷调查结果显示,手术效果非常满意89.3%（108/121）、满意9.0%（11/121）、不满意1.7%（2/121）。 结论: 在乳腺癌切除术同时采用乳房假体行即刻乳房再造可避免供区损伤,是一种理想的即刻乳房再造方法。采用阿基米德法对缺失乳房组织量进行计算并测量切除组织的直径,可相对准确地得到假体的参数,避免选择假体的盲目性,有利于获得良好的乳房再造手术效果。      

组织扩张术在即刻乳房再造中的应用

目的改进即刻乳房再造的手术方法,将软组织扩张术应用于即刻乳房再造术中,避免再造乳房术后出现"补丁样"外观,并保留乳房再造的最佳条件。方法在乳腺癌切除后即刻于胸大肌后间隙置入圆形扩张器,并于术后8~12周注水扩张至理想体积。Ⅱ期再造手术采用硅凝胶乳房假体、背阔肌肌皮瓣+硅凝胶乳房假体、背阔肌肌皮瓣及DIEP皮瓣置换扩张器完成乳房再造。结果 2009年6月至2011年6月,采用该技术进行扩张法即刻乳房再造36例,平均完成乳房再造时间3.5个月。术后无假体外露、皮瓣坏死等并发症出现,也无原手术切口的延长或新手术切口增加。术后随访6~12个月,患者对手术效果满意率达97.2%。结论采用组织扩张法进行即刻乳房再造,可以保留最佳的乳房再造条件,避免了术后放疗对乳房假体的影响,可以避免由于采用皮瓣修补胸部皮肤缺损而出现的"补丁样"外观,是理想的即刻乳房再造方法之一。     

乳腺切除术后全乳再造37例临床研究

目的探讨带血管蒂转移皮瓣在乳腺癌术后乳房再造中的安全性和整形效果。方法2004年3月—2010年6月,对37例乳腺肿瘤患者,行乳房切除术后带蒂背阔肌或TRAM皮瓣乳房再造。其中Ⅰ期再造34例,Ⅱ期再造3例;对其中15例TRAM皮瓣再造的供区下腹部应用涤纶补片加强腹壁。结果1例TRAM皮瓣小部分坏死,6例Ⅰ期再造术后乳房本体皮肤坏死。3例背阔肌皮瓣再造发生背部皮下血清肿;3例TRAM皮瓣下腹中段脂肪液化,无腹壁膨隆或腹壁疝发生。随访2月—72月,1例肿瘤局部复发,1例肝转移。乳房外观评价,总体可接受度94.59％。 结论背阔肌或TRAM带血管蒂转移皮瓣再造是乳房切除术后行全乳再造的有效和安全的方法,应用涤纶补片加强腹壁可以有效预防腹壁软弱和腹壁疝形成。     

带蒂腹直肌皮瓣在乳房重建手术中的应用

随着人民生活水平的提高和医学技术的发展,乳腺癌患者接受全乳切除术后对乳房重建的需求日益增长。带蒂腹直肌皮瓣(transverse rectus abdominis muscle,TRAM)手术是重要的自体组织乳房重建方法。该文就TRAM皮瓣的解剖与血供、TRAM手术的适应证和禁忌证、手术步骤以及并发症进行介绍,同时还对TRAM手术中的一些细节问题进行了探讨。TRAM术式作为自体组织乳房重建技术,不需要假体,从而避免了假体相关的并发症。另外相比于假体重建,自体组织重建的外形和柔软度都更接近于自然乳房,具有更好的重建效果。同时带蒂的TRAM术式不需要显微血管吻合技术和密切的术后皮瓣检测,容易被外科医师掌握并在更多的医学中心开展。因此TRAM皮瓣仍然具有一定的应用前景。     

Breast reconstruction after mastectomy

The goal of breast reconstruction is to reconstruct breasts which meet the patient's expectations both psychologically and aesthetically, while adhering to the principles of sound oncological management. Breast reconstruction is usually started around 3 to 9 mos after mastectomy. The simplest method of reconstruction uses tissue available after mastectomy and a silicone implant. The recent advances with tissue expansion of the skin of the mastectomy site can permit reconstruction without the use of a flap. The latissimus dorsi flap from the back is a useful source of muscle and skin and the transverse rectus abdominus musculocutaneous flap provides tissue from the lower abdomen enabling breast reconstruction without the use of a silicone implant. Fat and skin from the buttocks may be used in a microsurgical transfer technique. Prophylactic mastectomy and immediate breast reconstruction are still controversial, but are options for the woman who is worried about the development of breast cancer. The reconstruction of the nipple and areola is only done after reconstructed breast symmetry is ascertained.     

Breast reconstruction with prosthetic implants

For patients who undergo mastectomy for the treatment of breast cancer, the restoration of a normal breast form through breast reconstruction is important to body image and quality of life. Implant-based reconstruction has the capability of producing excellent results in the well selected patient. In addition, compared with autogenous tissue reconstruction, implant reconstruction offers a shorter operative procedure with a quicker convalescence and no donor site morbidity. Reconstruction options for implant-based reconstruction include: single-stage reconstruction with a standard or adjustable implant, tissue expansion followed by placement of a permanent implant, or combined autologous tissue/implant reconstruction. Procedure selection is based on a range of patient variables, including: location and type of breast cancer, availability of local, regional and distant donor tissue, size and shape of the desired breast(s), surgical risk, and most importantly, patient preference. Although satisfactory results can be obtained with single-stage reconstruction, in most of patients, a more reliable approach involves two-stage expander/implant reconstruction. Individualizing selection of a reconstructive technique for each patient will be the predominant factor in achieving a reconstructive success.     

乳腺癌术后修复重建的临床经验

目的 探讨国人乳腺癌术后修复重建的经验。方法 回顾性分析2009年11月至2011年1月海南省农垦总医院收治的15例乳腺癌术后自体组织修复重建患者的临床资料。结果 15例手术患者中,即刻修复5例（4例为即刻修复临床Ⅳ期乳癌术后胸壁创面）,延期修复10例。单纯应用背阔肌肌皮瓣带蒂转移3例（2例为即刻修复保乳术后局部缺损）,背阔肌肌皮瓣带蒂转移加乳房假体3例,乳腺瓣修复保乳术后局部缺损1例,内窥镜辅助背阔肌肌瓣带蒂转移修复保乳术后乳腺局部缺损1例,组织扩张术行局部皮瓣转移2例。随访2～15个月,皮瓣全部成活,创面愈合良好,形态满意。结论 自体组织修复保乳术后的局部缺损对于乳房普遍较小的中国患者实用方便,设计灵活,可同时修复腋窝缺损,不影响放疗和化疗的及时进行,具有良好的应用前景。     

腹部皮瓣在乳房重建中的应用

乳腺癌已经成为严重危害女性身心健康的恶性肿瘤,其发病率高居榜首,且有年轻化的趋势。现阶段随着医疗的不断进步,人们越来越重视乳房的缺失对患者心理、形体造成的伤害,所以乳腺癌的外科治疗已经由传统的根治性手术朝着保乳、乳房重建的手术模式发展。国内外众多医疗机构针对乳房重建开展了大量研究和实践,根据重建填充物的不同,可以将乳房重建分为自体组织重建和植入物重建,而自体组织重建又可分为腹部皮瓣、背部皮瓣、腰部皮瓣、臀部皮瓣及腿部皮瓣,其中腹部皮瓣因其血供好、组织量够大、远期效果好且具有腹部塑型的作用被广泛用于乳房重建及胸壁缺损的修复。本文将应用腹部皮瓣进行乳房重建的技术要点和相关并发症进行总结,旨在探讨腹部皮瓣乳房重建的最新进展。     

乳腺癌术后可扩张假体与自体组织乳房重建的临床比较

目的:探讨并比较分析保留皮肤乳腺切除术后,应用即刻可扩张假体植入乳房重建与即刻自体组织乳房重建的手术方法、效果及并发症.方法:60例患者行保留皮肤的乳腺改良根治术后乳房重建,其中可扩张假体植入重建43例,即刻自体组织重建17例.根据乳房的体积、形状、与对侧乳房的对称性比较及患者满意度,评价两种手术的效果.结果:随访12个月,可扩张假体乳房重建组到达良好以上为93％,自体组织重建组为86％,两种重建方法治疗效果差异无统计学意义.可扩张假体植入乳房重建安全可靠,手术效果好,并发症少.结论:可扩张假体植入即刻乳房重建扩大了假体植入乳房重建的手术适应证,是一种值得推广的手术方式.     

Breast reconstruction following mastectomy

Breast reconstruction after mastectomy can avoid a permanent deformity. As a member of the breast management team, the reconstructive surgeon can give advice on timing and techniques. Breast reconstruction can either be started at the time of the mastectomy or delayed for months or years. Newer techniques of tissue expansion permit breast reconstruction without additional scars or significant hospitalization. Autogenous tissue breast reconstruction techniques are available that provide natural, long-lasting breast reconstruction without the need for a silicone breast implant.     

Cosmetic reconstruction after resection of breast cancer: use of the ELD-MC flap and EVRAM flap

Breast reconstruction following the resection of breast cancer with inadequate residual chest-wall tissue may be performed with an implant or a myocutaneous flap, such as the latissimus dorsi or a rectus abdominis. Among a variety of operative procedures, each method has advantages and disadvantages. The insertion of a silicone-bag prosthesis is the easiest method, but the prosthetic implant sometimes has complications, such as unfavorable capsular contracture formation around the implant, rupture, infection, or exposure. We therefore use an extended latissimus dorsi myocutaneous (ELD-MC) flap with some amount of surrounding subcutaneous fat from the lumbar area, and avoid the use of any implant with an MC flap. Also, for the reconstruction and correction of infraclavicular and axillary depression, we use the extended vertical rectus abdominis myocutaneous (EVRAM) flap. This method uses the skin and fat on both sides of the umbilicus as a lenticular flap vascularized by only one of the rectus abdominis muscles. The patients are satisfied with the outcome because symmetry and good breast volume can be obtained. There have been no functional or anatomical defects of the donor area. No abdominal hernia after an EVRAM flap has resulted to date. Both the ELD-MC and EVRAM flaps can be successfully used for cosmetic breast reconstruction after the resection of breast cancer.     

Direct to Implant Breast Reconstruction With Prepectoral Micropolyurethane Foam-Coated Implant: Analysis of Patient Satisfaction

BackgroundImmediate implant reconstruction after mastectomy with submuscular implant placement is widely used in order to avoid implant exposure, capsular contracture and poor aesthetic result. Postoperative complications can be reduced by maintain mastectomy flap thickness and asses flap vascularity with near infrared imaging. The prepectoral reconstruction with polyurethane implants has been utilized with encouraging results. Postoperative patient satisfaction was assessed with the BREAST-Q scores in patients who underwent prepectoral reconstruction with polyurethane implants. Additionally the impact of mastectomy flap thickness on breast reconstruction was investigated.Materials and MethodsThe Breast Q-scores of satisfaction with the breast, the postoperative outcome and physical well-being of the chest in 70 patients underwent immediate implant breast reconstructions with prepectoral polyurethane implant were retrospectively reviewed. The correlation between mastectomy flap thickness and satisfaction with breast was analyzed.ResultsAt 12-month follow-up the mean Q-score for satisfaction with breast was 71.73 (standard deviation: 13.31), and for physical well-being chest was 70.73 (standard deviation: 7.94). A positive linear correlation between mastectomy flap thickness and satisfaction with the breast was identified.ConclusionsThe postoperative Q-scores are encouraging in the use of polyurethane prepectoral implants in immediate breast reconstruction, especially in patients with “thick” mastectomy flaps.