摘要
目的探索保留乳头乳晕的早期乳腺癌切除加背阔肌肌皮瓣Ⅰ期乳房重建术的可行性及治疗效果。方法回顾性分析广西医科大学附属肿瘤医院2013年3月至2017年6月期间收治的,接受保留乳头乳晕的乳房皮下腺体切除联合前哨淋巴结活检或腋窝淋巴结清扫术加背阔肌肌皮瓣Ⅰ期乳房重建术的早期乳腺癌病人(乳房重建组)32例临床病理资料,同时根据肿瘤最大径,肿瘤边缘到乳头乳晕距离,腋窝淋巴结转移个数,激素受体及HER2情况配对后按1∶1选配同期接受患侧乳房单纯切除联合前哨淋巴结或者腋窝淋巴结清扫术的早期乳腺癌病人(全乳房切除组)32例。比较两组病人术后并发症、术后拔管时间、术后乳房外形美容程度、术后生命质量及短期局部复发转移率等方面来分析两组病人的治疗效果。结果乳房重建组与全乳房切除组皮下积液发生率分别为18.75%比12.50%(χ^2=0.474,P=0.491),皮瓣坏死发生率分别为9.38%比6.25%(χ^2=0.000,P=1.000),切口感染发生率分别为3.13%比0.00%(P=1.000),切口愈合不良发生率分别为3.13%比3.13%(χ^2=0.000,P=1.000),两组患者患肢均无活动障碍,乳房重建组在皮下积液、皮瓣坏死和切口感染率与常规手术组比较差异无统计学意义(P>0.05);在术后拔管时间上乳房重建组长于全乳房切除组,分别为(17.29±8.79)d比(9.81±3.16)d(P=4.530,P=0.000),差异有统计学意义(P<0.05),乳房重建组术区愈合时间长于常规手术组。两组患者术后乳房外形美容程度评价中,乳房重建组优为17例,良为10例,一般为5例,无外形差病例,优良率达到84.38%,全乳房切除组外形均评价为差,乳房重建组术后乳房外形美容评价明显优于全乳房切除组(P<0.05)。同时乳房重建组病人术后生命质量评价中优于全乳房切除组(P<0.05)。乳房重建组和全乳房切除组中位随访时间分别为28和27个月,乳房重建组局部和全乳房切除组复发率为3.13%比3.13%(χ^2=0.000,P=1.000)、远处转移率0.00%比3.13%(P=0.500),均差异无统计学意义(P>0.05)。结论与全乳房切除根治手术相比,保留乳头乳晕的早期乳腺癌切除加背阔肌肌皮瓣Ⅰ期乳房重建术虽然增加了术后拔管时间,但术后并发症是可控的;同时其可显著改善乳腺癌病人术后乳房的外形及提高病人的术后生命质量,且疗效相当好,安全可行,值得临床推广。
Objective To explore the feasibility and effect of immediate latissimus dorsi myocutaneous flap breast reconstruction after nipple-sparing mastectomy for early breast cancer.Methods Retrospective analysis was made about the clinical data of 32 patients who underwent latissimus dorsi flap breast reconstruction after nipple-sparing subcutaneous mastectomy combined with sentinel lymph node biopsy or axillary lymph node dissection(breast reconstruction group)from March 2013 to June 2017 in The Affiliated Cancer Hospital of Guangxi Medical University.Another 32 patients with early breast cancer(mastectomy group)who underwent simple resection of the affected breast combined with sentinel or axillary lymph node dissection during the same period were selected by 1∶1 according to the maximum diameter of the tumor,the distance from the edge of the tumor to the nipple areola,the number of axillary lymph node metastasis,hormone receptor and HER2.By comparing the two groups of patients in postoperative complications,postoperative extubation time,postoperative breast cosmetics,postoperative life quality and short-term local recurrence and distant metastasis rate,the therapeutic efficacies of the two groups were analyzed.Results The incidence of subcutaneous effusion in breast reconstruction group and total mastectomy group was 18.75% vs.12.50%(χ^2=0.474,P=0.491),the incidence of skin flap necrosis was 9.38% vs.6.25%(χ^2=0.000,P=1.000),the incidence of incision infection was 3.13% vs.0.00%(P=1.000),and the incidence of poor wound healing was 3.13% vs.3.13%(χ^2=0.000,P=1.000).No limb movement disorder was found in both groups of patients.There were no significant differences in the rates of subcutaneous effusion,skin flap necrosis and incision infection between the breast reconstruction group and the mastectomy group(P>0.05). The time of extubation in the breast reconstruction group was longer than that in the total mastectomy group[(17.29±8.79)d vs.(9.81±3.16)d,P=4.530,P=0.000];the difference was statistically significant(P<0.05).The postoperative healing time in the breast reconstruction group was longer than that in the total mastectomy group.The postoperative breast cosmetic results were compared between the two groups.There were 17 excellent,10 good,5 average and no poor in breast reconstruction group,and the excellent and good rate was84.38%.The appearance of total mastectomy group was poor.The difference between the two groups was statistically significant(P<0.05).The assessment of breast cosmetic appearance of the breast reconstruction group was significantly better than that of the total mastectomy group.The life quality assessment of breast reconstruction group was better than total mastectomy group(P<0.05).The median follow-up time in breast reconstruction group and total mastectomy group was 28 and 27 months,respectively.In comparison of the breast reconstruction group and total mastectomy group the recurrence rate was 3.13% vs.3.13%(χ^2=0.000,P=1.000)and distant metastasis rate was 0.00% vs.3.13%(P=0.500).There were no significant differences in local recurrence rate and distant metastasis rate between the two groups(P>0.05).Conclusions Although,compared with radical mastectomy,the immediate latissimus dorsi myocutaneous flap breast reconstruction after nipple-sparing mastectomy for early breast cancer has increased the extubation time,the postoperative complications are controllable.It can significantly improve the breast appearance of the patients after operation and the patients’ postoperative life quality.What’s more,the theraputic effect is not only relatively good,but also safe and feasible.Therefore,it is worthy of clinical promotion.
作者
饶彬
杨华伟
RAO Bin;YANG Huawei(The Second Department of General Surgery,Hospital of Wuzhou Red Cross Society,Wuzhou,Guangxi Zhuang Autonomous Region 543002,China;Department of Breast Surgery,The Affiliated Cancer Hospital of Guangxi Medical University,Nanning,Guangxi Zhuang Autonomous Region 530021,China)
出处
《安徽医药》
CAS
2019年第10期2005-2010,I0004,共7页
Anhui Medical and Pharmaceutical Journal
关键词
乳腺肿瘤
乳房成形术
乳房切除术
改良根治性
外科皮瓣
保留乳头乳晕
背阔肌肌皮瓣
Breast neoplasms
Mammaplasty
Mastectomy,modified radical
Surgical flaps
Nipple areola sparing
Latis-simus dorsi myocutaneous flap
