摘要
目的探讨带蒂胸外侧动脉穿支皮瓣在乳腺癌整形保乳术中的应用。方法 2015年6月至2018年6月, 郴州市第一人民医院乳腺甲状腺外科收治拟行整形保乳术的乳腺癌女性患者48例[年龄28~55(42±3)岁)], 分为常规保乳组和整形保乳组各24例。常规保乳组用切缘周围筋膜瓣移位修复, 整形保乳组用带蒂胸外侧动脉穿支皮瓣转移修复;比较两组手术相关指标及术后美容效果差异。结果两组患者均成功完成保乳手术。整形保乳组在手术时间、术中出血量、手术切口长度及引流管留置时间较常规保乳组增加, 差异均有统计学意义(t值分别为6.99、9.37、21.74、8.80, 均P<0.05);但2次手术扩切率明显低于常规保乳组, 差异有统计学意义(χ^(2)=4.76, P<0.05)。整形保乳组有3例、常规保乳组有1例出现皮瓣边缘皮肤缺血坏死, 经换药引流后愈合。术后美容效果显示, 整形保乳组优良率(91.7%)明显高于常规保乳组(58.3%), 差异有统计学意义(χ^(2)=7.11, P<0.05)。术后患者随访中位数36个月, 无局部复发及远处转移。结论带蒂胸外侧动脉穿支皮瓣转移修复乳腺癌保乳术中局部缺损, 可操作性强, 切口隐蔽及美容效果好, 值得临床应用。
Objective To explore the clinical application of lateral thoracic artery perforator flap in repairing local defect after breast conserving surgery.Methods The clinical data of 48 breast cancer patients planned to finish breast conserving surgery were retrospectively analyzed.The patients were divided into plastic breast-conserving group and routine breast conserving group.In the plastic breast-conserving group,24 patients local defect repaired with the lateral thoracic artery perforator flap.In the routine breast conserving group,24 patients local defect repaired with the fascial flap around the cutting edge.The operation related indexes and cosmetic effect from two groups were compared.Results Both groups of patients successfully completed breast conserving surgery.The plastic breast-conserving group patients had significantly increased in operation time,operative blood loss,incision length and drainage tube indwelling time compared with the routine breast conserving group;the differences were statistically significant(t=6.99,9.37,21.74,8.80,P<0.05).The rate of secondary surgery enlarged was lower than fhat in the routine breast conserving group,and the difference was statistically significant(χ^(2)=4.76,P<0.05).There were 3 cases in the plastic breast conserving group and 1 case in the conventional breast conserving group.The skin at the edge of the flap was ischemic necrosis in the 4 cases,which healed after dressing change and drainage,and there was no significant difference(P>0.05).The evaluation of postoperative cosmetic effect showed that the excellent and good rate of the observation group was 91.7%,compared with the routine breast conserving group(58.3%);the difference was statistically significant(χ^(2)=7.11,P<0.05).All patients were followed up for average 24 months,and local recurrence and distant metastasis were not observed.Conclusions The lateral thoracic artery perforator flap for filling local defects in the lateral quadrant or central region of breast cancer is feasible,easy to operate,hides incision scar,better cosmetic effect and worthy of clinical promotion.
作者
何建怀
卢衡凭
李小荣
王先明
易石坚
屈洪波
He Jianhuai;Lu Hengping;Li Xiaorong;Wang Xianming;Yi Shijian;Qu Hongbo(Department of Breast and Thyroid Surgery,the First People’s Hospital of Chenzhou,Chenzhou 423000,China;Department of Gastrointestinal Surgery,the Third Xiangya Hospital,Central South University,Changsha 410013,China;Department of Thyroid and Breast Surgery,the South China Hospital of Shenzhen University,Shenzhen 518100,China)
出处
《中华医学美学美容杂志》
2022年第5期390-394,共5页
Chinese Journal of Medical Aesthetics and Cosmetology
基金
湖南省郴州市科技局课题(ZDYF2020032)。
关键词
乳腺肿瘤
保乳术
胸外侧动脉
穿支皮瓣
美容效果
Breast neoplasms
Breast-conserving surgery
Lateral thoracic artery
Perforator flap
Cosmetic effect
