即时扩展型背阔肌肌皮瓣乳房再造术常见失误及并发症探讨

目的探讨乳腺癌改良根治术后应用扩展型背阔肌肌皮瓣即时乳房再造的常见失误和并发症的处理。方法回顾41例行保留皮肤或保留乳头乳晕乳腺癌改良根治术后即时扩展型背阔肌肌皮瓣乳房再造病例,分析手术失误和并发症发生原因及预防处理措施。结果 41例乳房再造手术均获成功。术后情况:7例美容效果欠佳,18例血清肿,7例皮瓣坏死,3例干性皮肤坏死,2例翼状肩,2例乳头部分坏死,1例发生感染。结论乳腺癌术后应用扩展型背阔肌肌皮瓣即时乳房再造形态良好,并发症虽然较高,但严重并发症相对少,且可以有效预防或减少,适合中国女性,作为目前我国乳腺肿瘤治疗的一种有效补充手段,有一定临床应用价值。

Study of lapsus and complications after immediate breast reconstruction with extended latissimus dorsi flap

Objective To study the prevention and treatment of lapsus and complications after immediate breast reconstruction using extended latissimus dorsi （ELD） flap after skin sparing or nipple sparing modified radical mastectomy. Methods The modified radical mastectomy was carried out in 41 patients, and then immediate breast reconstruction was performed with ELD flap in all patients. Lapsus and complications were analyzed. Results All the 41 patients obtained successful breast reconstruction. As for the cosmetic effect of the reconstructed breasts, 7 cases had poor result, doral seromas was in 18 cases, skin flap necrosis or mild skin exfoliate in 7 cases, dry skin necrosis in 3 cases, winged shoulders in 2 cases, nipple necrosis in 2 cases and infection in 1 case. Conclusion Immediate breast reconstruction with extended latissimus dorsi flap after modified radical mastectomy can obtain fine breast shape. The lapsus and complications can be controlled and decreased. This technique fits Chinese women, and is a effective method in breast cancer treatment .