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。

Nerve anastomosis and immediate breast reconstruction with TRAM flap after the mastectomy of breast cancer

Objective:To introduce the experience of immediate breast reconstruction with transverse rectus abdominis myocutaneous flap(TRAM) after the mastectomy of breast cancer,and discuss the effect of nerve anastomosis in the reconstructed breast sensory recovery.Methods:Twenty three cases with breast cancer underwent immediate breast reconstruction with unipedicled or bipedicled TRAM flap afier the mastectomy 18 by unipedicled,4 by bipedicled TRAM and 1 by free-TRAM.4 cases underwent the nerveanastomosis,7 cases received the vessel anastomosis.Results:All the reconstructions were successful,no local recurrence was found by the follow-up of 2-72months.The aesthetic results were well and the sensory of skin is superior to that in reconstructed breast without nerve anastomosis.Conclusion:Immediate breast reconstruction after the mastectomy of breast cancer can obtain aesthetic effect without affect the therapy of cancer;nervenanstomosis may recover the sensibility of skin,and improve the quality of life.