保留乳房天然结构的乳腺癌改良根治术后即刻乳房成形术的临床应用

目的探讨保留乳房天然结构的乳腺癌改良根治术后即刻自体组织乳房成形术在临床中的运用价值。方法乳腺癌患者12例，其中DCIS 6例，浸润性导管癌3例，小管癌1例，髓样癌1例，黏液癌1例；保留乳房皮肤的乳腺癌改良根治术9例，保留乳头乳晕复合体的乳腺癌改良根治术3例。全组均保留或重建乳房下皱襞，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背阔肌肌皮瓣即刻乳房成形。结果横行腹直肌肌皮瓣乳房成形术3例，背阔肌肌皮瓣乳房成形术9例，术后皮瓣均存活，皮瓣血管通畅，成形乳房外观良好。结论对早期乳腺癌患者行保留乳房天然结构的乳腺癌改良根治术后即刻自体组织乳房成形，切口隐蔽，成形乳房形态效果良好，可以获得较好的美容效果。

Immediate breast reconstruction after natural breast structure-conserving mastectomy

Objective To evaluate the application of immediate breast reconstruction with autologous tissue after natural breast structure-conserving mastectomy. Methods Twelve patients with breast cancer were enrolled in the study, including 6 cases of ductal carcinoma in situ （DCIS） , 3 of invasive ductal carcinoma, 1 of tubular carcinoma, 1 of medullary carcinoma, and 1 of mucinous carcinoma. Nine patients received skin-sparing mastectomy, and 3 received nipple-sparing mastectomy, All of these cases had breast tissue and axillary lymph nodes removed, but with mammary fold conserved or reconstructed. Transverse rectus abdominis myocutancous（TRAM） flap or latissimus dorsi muscle（LDM） flap were used in immediate breast reconstruction. Results The flap of reconstructed breasts survived with patend blood and good look in all of the 12 cases, including 3 cases of TRAM flap reconstruction and 9 of LDM flap reconstruction. Conclusion The hidden incision, good shape and cosmetic effects of reconstruction breast are included in the advantages of immediate breast reconstruction after natural breast structure-conserving mastectomv for patients with early breast cancer.