乳腺癌术后横行腹直肌皮瓣乳房再造的适应证剖析

目的探讨乳腺癌术后下腹部横行腹直肌（transverse rectus abdominal myocutaneous，TRAM）皮瓣乳房再造术的适应证的选定，并进行临床剖析。方法对17例乳腺癌切除术后患者应用对侧单蒂TRAM皮瓣进行乳房再造，其中I期再造者7例，Ⅱ期再造10例，均为乳腺癌改良根治术后患者。9例Ⅱ期进行乳头、乳晕再造。12例供区下腹部应用涤纶补片加固腹壁以预防腹壁软弱和腹壁疝形成。由多学科诊疗小组对适应证选择，并进行总结和分析。结果17例经过5个月至6年的观察，2例Ⅱ期再造术后，TRAM皮瓣的皮肤发生小面积坏死，1例对侧下腹壁轻度膨隆，无腹壁疝，经过对症处理，17例均取得较好疗效。结论对于乳腺癌术后具有适应证的患者应用横行TRAM皮瓣乳房再造术是一种较为有效和安全的方法。严格选定适应证，是乳房再造成功的关键。

Application of transverse rectus abdominal myocutaneous flap in breast reconstruction for post-mastectomy patients with breast tumors

Objective To study the application of transverse rectus abdominal myocutaneous (TRAM) flap in breast reconstruction for post mastectomy patients with breast tumors and to analyze their clinical treatment.Methods From 2004-2010,17 patients with breast tumor were received reconstruction surgery using their opposite TRAM single flap.7 of them received the first period and 10received in the second period reconstruction.All these cases were post-mastectomy.9 cases were addi tionally given nipple-areola reconstruction.12 of them were applied for dacron patch in lower abdomen to strengthen abdominal wall,preventing wall weakness and lateral ventral syndrome.All results were analyzed individually and treatment were given according to their clinical status.Results Two of 17TRAM flap were necrosis after 6 months to six years follow up.1 case had opposite abdominal wall slightly swelling with no lateral ventral syndrome.All 17 cases were successful by giving appropriate treatments.Conclusions TRAM flap reconstruction is an effective and safe method for those postmastectomy patients with any indications for operation.Carefully individual measurements for patients is the key to the success of breast reconstruction.