乳房成形术在乳腺癌保乳术后缺损修复中的应用

目的 对比分析乳腺癌不同保乳手术治疗中乳房缺损修复的方法,分析其各自的特点.方法 收集昆明医科大学第三附属医院乳腺科2011年10月至2014年3月期间,采用双环法＋腺体修复成形术,带蒂背阔肌肌皮瓣和邻近皮瓣修复保乳术后乳房缺损等方法,进行保乳手术治疗中乳房缺损修复的乳腺癌病例,术后随访3 ～ 24个月,采用体检测量和满意度调查的方式评价手术后乳房的美容效果.结果 共收集到乳腺癌保乳术后缺损修复病例124例,其中保乳手术时采用双环法＋腺体修复成形术对乳房缺损进行修复50例,采用带蒂背阔肌肌皮瓣修复48例,采用邻近皮瓣修复26例,手术均获得成功;术后3 ～ 24个月随访,3种方法乳房美容效果评分为21及以上者分别为36例（72.0％）、26例（54.2％）和18例（69.2％）,经卡方检验分析得出,采用双环法＋腺体修复成形术修复保乳术后乳房缺陷的效果优于另外2种方法,P＜0.05;3种方法患者满意度分别为：94.0％、87.5％和92.3％,双环法＋腺体修复成形术满意率高于另外2种方法,差异有统计学意义,P＜0.05.结论 乳腺癌早期患者,采用双环法＋腺体修复成形术对保乳术后乳房缺损进行修复,术后乳房美容效果更好,患者满意度高,是值得推荐的一种手术方式.

Application of Mammoplasty in Breast Defect Repair after Breast Cancer Conservative Surgery

Objective To analyze the different types of breast surgery for repair of breast defect after breast cancer conservative surgery,and their characteristics.Methods We collected the data of breast surgeries of our department from October 2011 to March 2014,in which the three different kinds of methods were applied to the breast conservative surgery for breast cancer,namely,the double loop method ＋ repair keratoplasty glands,conserving surgery of breast with pedicled latissimus dorsi muscle flap and local defect repair by adjacent flap prothesis.After the surgery,patients were followed up for 3 months to 2 years.During the time,the evaluation of the breast cosmetic effect was made by medical measurement and satisfaction survey.Results Altogether,there were 124 cases of breast conservative surgeries for breast cancer.Among which,there were 50 cases that applied the double loop method ＋ repair keratoplasty glands,48 cases applied the conserving surgery of breast with pedicled latissimus dorsi muscle flap and the other 26 cases applied the local defect repair by adjacent flap prothesis.All the surgery succeeded.As for the evaluation of the three kinds of surgery,the grade which the surgeries got was 21 and above were 36 （72.0％）,26 （54.2％） and 18 （69.2％） respectively.It was apparent that the double loop method ＋ repair keratoplasty glands was better than the other two methods by Chisquared test P＜0.05.And according to the patients＇ satisfaction research,the satisfaction of the three methods were 94.0％,87.5％ and 92.3％.Which also indicated that the patients were much more satisfied with the double loop method ＋ repair keratoplasty glands.Meanwhile,all the differences were statistically significant P＜0.05.Conclusion For the earlier patients who suffered breast cancer,the double loop method ＋ repair keratoplasty glands often get better breast cosmetic effect,and patients are much satisfied of the surgery,so the method is worthy applying in the surgery.