乳腺癌改良根治术后即刻乳房再造不同方法的临床应用

目的：探讨乳腺癌改良根治术后即刻乳房再造不同方法的适应证、手术方法及优缺点。方法：本组37例乳腺癌患者，分别采用横形腹直肌肌皮瓣带蒂转移、腹壁下动脉穿支皮瓣吻合血管游离移植、背阔肌肌皮瓣带蒂转移、单纯乳房假体置入以及不同方法相结合进行术后即刻乳房再造。结果：除2例单纯TRAM皮瓣患者近腋窝皮瓣局部坏死，1例TRAM＋DIEP联合皮瓣患者下腹正中局部皮瓣脂肪液化外，余34例皮瓣全部成活，形态满意。随访5个月-10年，无腹部薄弱或腹壁疝等并发症，患者生活质量均得到提高。结论：乳腺癌术后即刻再造安全可行，不同的方法各有优缺点，应根据患者具体情况选择适合患者本人的方法进行乳房再造。

Clinical experiences of immediate breast reconstruction using different methods after modified radical operation of breast cancer

Objective：To investigate the indications,surgical methods,advantages and effects of different methods for breast reconstruction following modified radical operation. Methods ： Thirty seven cases of immediate breast reconstruction were performed by using different methods, such as pedicled TRAM （ transverse abdominal myocutaneous flap） ,free DIEP （ deep inferior epigastric perforator flap） ,latissimus dorsi musculocutaneous flap,full -size implant or combining one or two of these methods. Results ： Except 2 pedicled TRAM flap failed due to partial flap necrosis, 1 case of TRAM and DIEP combining flap suffered from fat necrosis, all the other flaps survived completely with satisfied shape. No recurrence cases or abdomen hernia happened within 5 months to 10 years follow -up,the patients＇life quality was improved. Conclusion：Immediate breast reconstruction after surgical breast treatment is safe and effective; It can cure patients both physically and psychologically. Certain method should be chosen for patients according to personal situation.