神经吻合术与乳腺癌术后即刻 TRAM 皮瓣乳房再造

目的：介绍乳腺癌术后应用下腹横型腹直肌肌皮瓣（TRAM皮瓣）即刻乳房再造的方法，并探讨神经吻合对再造乳房皮肤感觉恢复的疗效。方法：23例乳腺癌患者改良根治术后，Ⅰ期应用单蒂或双蒂横型腹直肌肌皮瓣（TRAM）行乳房再造，单蒂TRAM乳房再造18例，双蒂TRAM乳房再造4例，游离TRAM乳房再造1例，对4例患者进行了神经吻合术，对7例患者进行了血管吻合术。结果：再造手术均取得成功，经过2—72个月随访，无局部复发。行神经吻合的患者再造乳房皮肤感觉较没有行神经吻合者好，患者对再造乳房满意度高。结论：乳腺癌术后Ⅰ期乳房再造能同时满足肿瘤的治疗和形体美容的要求，并且神经吻合术可以一定程度恢复再造乳房皮肤感觉，提高生活质量。     

女性乳腺癌保留胸大肌术后Ⅰ期乳房再造

目的：探讨乳腺癌改良根治术同时行上蒂横行腹直肌带蒂肌皮瓣（TRAM）Ⅰ期乳房再造的可行性。方法：行乳腺癌改良根治术Ⅰ期乳房再造7例，其中1例同时行乳头乳晕再造、1例行Ⅱ期乳头乳晕再造。结果：6例患者转移皮瓣全部成活，1例部分皮肤血运欠佳，经二次处理后痊愈。再造乳房术后外观评价：良6例，差1例。结论：此术式既达到了乳腺癌根治的目的又得到了乳房重建的效果，是治疗Ⅰ、Ⅱ期乳腺癌值得推荐的好方法。     

保留皮肤的乳腺癌改良根治术后即时乳房再造15例

目的探讨一种既达到肿瘤根治性切除,又保留乳房美观外形的乳房再造的手术方法。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。结果应用下腹部横行腹直肌肌皮瓣乳房再造10例,扩大背阔肌肌皮瓣再造5例。优11例（73．3％）,良4例（26．7％）。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。对早期乳腺癌患者是一种安全可行的治疗方法。     

双蒂横行腹直肌肌皮瓣在双侧乳腺癌术后即刻乳房重建中的应用

双侧乳腺癌同时进行双侧乳腺切除，术后胸部缺损严重，使患者身心遭受双重打击，极大影响其生活质量。随着自体组织移植乳房重建手术的日益成熟和发展，乳腺癌患者要求乳房重建者日渐增多。本科于2004年4月至2007年8月对3例双侧乳腺癌改良根治术后患者采用双蒂下腹部横行腹直肌肌皮瓣（transverse rectus abdominis myocutaneous flap，TRAM）行即刻双侧乳房重建，均获得成功，重建乳房效果满意。现报告如下。     

自体组织乳房再造手术方式的变迁

乳房再造是乳腺癌治疗的一部分。多项研究表明：乳腺癌术后实施乳房再造不会对肿瘤演变过程产生不良影响；乳房再造患者的局部肿瘤复发率或生存率均与对照组无明显差异，并且不妨碍肿瘤复发的早期发现。同时，大量的心理研究结果提示：乳房再造对患者心理恢复确实有正面影响，能使患者在情绪稳定、社会功能、精神健康状况等方面都有明显改善。     

乳腺癌根治术I期横型腹直肌肌皮瓣乳房再造

乳腺癌是一种严重影响妇女身心健康甚至危及生命的常见病和多发病，其发病率在我国占全身各种恶性肿瘤的7～10％，且发病率逐年上升，呈年轻化趋势。现在，乳腺癌早期诊断病例的增加和综合治疗的进展，患者多能长期生存，甚至获得治愈，乳腺癌是目前临床治疗效果最佳的实体肿瘤之一。根治性手术切除仍是国内治疗乳腺最主要的手段。因此，乳房缺如(全切除)或乳房毁形(部分切除)的病例持续     

乳腺癌乳房切除术后两种不同即刻再造方法的并发症和生存分析

目的 比较乳腺癌乳房切除术后两种不同即刻再造方法 的并发症和患者的生存情况.方法 选取女性乳腺癌患者128例,根据治疗方法 不同将患者分为带蒂横行腹直肌肌皮瓣组(腹直肌组)和带蒂横行背阔肌肌皮瓣组(背阔肌组),每组各64例.对两组患者的术后并发症发生情况、骨转移、全身多处转移、局部复发及死亡情况进行统计分析.结果 腹直肌组患者的术后并发症发生率和局部复发率均低于背阔肌组(P<0.05);两组患者的骨转移率、全身多处软组织转移率和病死率比较,差异无统计学意义(P>0.05).结论 乳腺癌乳房切除术后带蒂横行腹直肌肌皮瓣即刻乳房重建术较背阔肌临床效果好.     

横行腹直肌肌皮瓣应用于乳腺癌术后即时乳房再造的临床研究

目的探讨横行腹直肌肌皮瓣(TRAM)应用于乳腺癌术后即时乳房再造的临床研究。方法选取2016年4月至2018年4月间广东省高州市人民医院收治的行TRAM乳房重建术治疗的20例乳腺癌患者为TRAM组,另同期选取采用背阔肌肌皮瓣再造术(LDM)治疗的20例乳腺癌患者为LDM组。比较两组患者乳房再造术后外观、乳房体积变化和术后并发症。结果两组患者术中出血量、手术时间、住院时间和住院总费用比较,差异无统计学意义(P <0. 05)。TRAM组患者乳房重造后外观评价优良率为95. 0%,LDM组为90. 0%,两组组间比较,差异无统计学意义(P> 0. 05)。重复测量方差分析显示,两组患者不同时点乳房重建后乳房体积比较,差异有统计学意义(P <0. 05)。且术后1、3、6、12个月,两组患者的乳房体积比较,差异无统计学意义(P> 0. 05)。两组患者术后伴有局部积液和血肿等并发症,两组患者乳房重造后并发症总发生率比较,差异无统计学意义(P>0. 05)。结论乳腺癌术后即时TRAM乳房再造方法术中出血少,再造乳房外观较佳,且术后并发症少,对乳腺癌根治术后患者生活质量的提高具有积极意义。     

部分筋膜法TRAM皮瓣在乳腺癌根治即刻乳房重建中的应用

目的:探讨采用保留部分前鞘的下腹部横行腹直肌肌皮瓣(TRAM)即刻乳房重建在乳腺癌根治中的应用及效果.方法:对接受乳腺癌根治术的14例患者(Ⅰ、Ⅱ期9例,Ⅲ期5例),于根治术即刻采用保留部分前鞘的TRAM皮瓣重建乳房.所有患者术后均常规行放化疗或内分泌治疗.结果:本组14例皮辩均成活,无并发症.随访2～26个月,未见肿瘤复发和转移,未见腹壁疝和腹壁膨出发生.重建乳房外形可,与健侧对称性可,弹性好,患者自我满意度高.结论:部分筋膜法TRAM皮瓣即刻再造重建,可保持传统TRAM皮瓣手术的效果并降低术后腹壁并发症的发生率.放化疗和内分泌治疗不影响皮瓣的成活.     

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。     

早期乳腺癌保留乳头乳晕复合体的改良根治术--Ⅰ期腹直肌肌皮瓣重建乳房

背景与目的：改良根治术目前已成为早期乳腺癌主要外科治疗方法之一,但术后如何重建乳房及保留乳头乳晕复合体一直是争论的焦点。本研究探讨早期乳腺癌保留乳头乳晕复合体的改良根治术——Ⅰ期腹直肌肌皮瓣重建乳房的方法及临床应用。方法：对早期乳腺癌患者行皮下乳腺切除,腋窝淋巴结清除,腹直肌肌皮瓣Ⅰ期乳房再造,最大限度地保留乳房皮肤以及乳头乳晕复合体。结果：应用该方法治疗10例早期乳腺癌,术后随访24～48个月,所有病例均无肿瘤局部复发及远处转移,重建乳房外形良好,乳头乳晕区皮肤无坏死,皮肤无明显萎缩、变硬,半年后乳头感觉恢复,供区无腹壁疝形成。结论：保留乳头乳晕复合体的乳腺癌改良根治术——Ⅰ期腹直肌肌皮瓣重建乳房,外形效果良好,对早期乳腺癌要求保持乳房外形的患者可能是一种较好的治疗方法;因本研究例数较少,该技术的疗效有必要行更大样本的研究来证实。     

Secondary breast reconstruction after mastectomy using the DIEP flap

Introduction

Breast reconstruction is an important element in the successful therapy of breast cancer [1]. Thereby, autologous microvascular breast reconstruction has been shown to be a reliable technique. The use of a deep inferior epigastric perforator (DIEP) flap or a muscle-sparing (MS) free transverse rectus abdominis musculocutaneous (TRAM) flap is recognized in many centres as gold standard for reconstructive options [[2], [3], [4]]. Based on our experiences with 137 patients over a 5-year period we want to highlight the technical aspects of the free microsurgical autologous breast reconstruction using a DIEP flap.

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.     

保留皮肤的青年乳腺癌改良根治术后即刻乳房再造与改良根治术的比较分析

目的：比较保留皮肤的乳腺癌改良根治术后即刻乳房再造与改良根治术对青年患者的疗效,并对乳房再造患者的预后因素进行分析。方法：回顾性分析柳州市人民医院2008年7 月至2014年6 月收治并行保留皮肤的乳腺癌改良根治术后即刻乳房再造组（60例）与改良根治术组（68例）的青年乳腺癌患者临床病理资料,比较两组间局部复发、无瘤生存及总生存,并分析年龄、肿瘤大小、是否保留乳头乳晕等因素对乳房再造患者生存的影响。结果：所有病例随访15～88个月,中位时间51个月。即刻乳房再造组局部复发3 例,远处转移8 例,死亡5 例,3 年无瘤生存率91.7% ,5 年无瘤生存率81.7% ,总生存率91.7%;改良根治术组局部复发2 例,远处转移9 例,死亡5 例,3 年无瘤生存率94.1 % ,5 年无瘤生存率83.8% ,总生存率92.6% ,两组比较均差异无统计学意义（均P > 0.05）。 即刻乳房再造组患者预后分析显示,淋巴结转移及雌孕激素受体阴性与无瘤生存率、总生存率相关（均P <0.05）。 结论：青年乳腺癌患者保留皮肤的改良根治术后即刻乳房再造组与改良根治术组在局部复发及远期生存方面无显著性差异,对于早期青年乳腺癌患者是安全的,保留乳头乳晕并未增加肿瘤复发风险,淋巴结转移及雌孕激素受体阴性是影响预后的主要因素。     

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。     

Concurrent adjuvant chemotherapy and immediate breast reconstruction with skin expanders after mastectomy for breast cancer

Background. Immediate breast reconstruction (IBR) by means of skin expander is currently one of the most widely used methods of breast reconstruction in mastectomized patients. However, given that many breast cancer patients usually receive adjuvant chemotherapy, the adoption of IBR raises new questions concerning possible cumulative toxicity. The present study reports our experience in the use of concurrent adjuvant chemotherapy and immediate breast reconstruction with skin expander after mastectomy for breast cancer and the acute cumulative toxicity of the treatments. Methods. We evaluated a consecutive series of 52 breast cancer patients who have received IBR by skin expander after radical mastectomy and adjuvant chemotherapy concurrently during skin expansion between 1995 and 1998 (IBR/CT group). We identified two series of control patients treated during the same period: 51 consecutive patients undergoing radical mastectomy and IBR without adjuvant chemotherapy (IBR group) and 63 consecutive patients undergoing radical mastectomy and adjuvant chemotherapy without IBR (CT group). For each patient, we evaluated the incidence of surgical complications and chemotherapy's side effects and dose intensity. Results. The interval between surgery and the start of expander inflation was similar in IBR/CT (range 0–19, median 5 days) and IBR groups (range 0–40, median 5 days) and the timing of inflation was not influenced by chemotherapy. The overall incidence of surgical complications in patients undergoing IBR was low: seroma in eight cases, infection in one, skin necrosis in one, expander rupture in two and erythema in three. There were no statistically significant differences in the distribution of complications between the IBR/CT and IBR groups. The dose intensity of chemotherapy was similar between IBR/CT and CT groups, with a median dose intensity of 96% and 95% of the projected dose, respectively. The only statistically significant difference in terms of chemotherapy side effects (p=0.03) was that stomatitis was more frequent and intense in the CT than in the IBR/CT group. Conclusions. Concurrent treatment with IBR and adjuvant chemotherapy appears feasible and safe, it does not increase acute surgical complications or chemotherapy side effects, and does not require any changes in dose intensity or the timing of inflation.     

Comparison of immediate breast reconstruction after mastectomy and mastectomy alone for breast cancer: A meta-analysis

Background

The purpose of this study was to compare patient outcomes between immediate breast reconstruction (IBR) after mastectomy and mastectomy alone.