扩大背阔肌肌皮瓣在乳腺癌即刻乳房再造中的应用

目的评价扩大背阔肌肌皮瓣在乳腺癌即刻乳房再造中的应用价值。方法收集2004年12月至2006年8月宣武医院应用扩大背阔肌肌皮瓣行乳腺癌术后即刻乳房再造病例的临床资料,并对手术技巧、并发症及再造乳房形态和病人的满意度进行分析。结果14例乳腺癌患者接受了扩大背阔肌肌皮瓣乳房再造,患者平均年龄43岁(24~51岁),Ⅰ期乳腺癌3例,Ⅱa期7例,Ⅱb期3例,Ⅲa期1例。手术后皮瓣全部存活;无伤口感染;供区血肿5例(35.7%),除1例需手术处理外,其他患者均经穿刺抽液治愈。背部局部伤口裂开1例,经换药伤口愈合。3例患者接受了放射治疗未发现不良后果。随访3~24月,患者对再造乳房形态非常满意9例,满意4例,一般1例,无不满意患者。结论乳腺癌术后扩大背阔肌肌皮瓣即刻乳房再造是一种较为简便、并发症少、效果良好的手术方法。

Immediate Breast Reconstruction with the Extended Latissimus Dorsi Flap in Patients with Breast Cancer

Objective To evaluate the results of immediate breast reconstruction with extended latissimus dorsi flap in patients with breast cancer following mastectomy. Methods The clinical data of the patients who have undergone immediate breast reconstruction with extended latissimus dorsi flap following mastectomy dating from December 2004 to October 2006 were collected. The operative technical detail, postoperative complications, esthetical results and patient satisfactions were analyzed. Results Fourteen patients with breast cancer underwent immediate breast reconstruction with extended latissmus dorsi flap following mastectomy, including stage Ⅰ, Ⅱa, Ⅱb , Ⅲa in 3, 7, 3, and one patient respectively. The mean age was 43 years(range, 24～51). The length of follow-up ranged from 3 to 24 months. There were no flap losses; Donor site seroma occurred in 5 patients(35.7%), one of which required surgical correction of non-resolving seroma, the others disappeared after repeated aspiration. Wound infection was not observed. One patient developed minor wound dehiscence. 9 patients were very satisfied with the reconstructive breast, 4 satisfied, 1 considered the result to be fair. None of the patients was not satisfied. Conclusion In selected patients with breast cancer the extended latissimus dorsi flap is a relatively easy and reliable method for total autologous breast reconstruction. However, this flap's main disadvantage is donor-site morbidity with prolonged drainage and risk of seroma.