一期假体植入乳房再造中保留胸大肌筋膜的初步研究

A preliminary study on retention of the pectoralis major muscle fascia in breast reconstruction with prosthesis at first stage

摘要:

目的 探讨早期乳腺癌在乳房切除术后采用保留胸大肌筋膜联合胸大肌肌瓣覆盖假体的一期乳房 再造临床应用价值。方法 收集湖南省人民医院2015 年6 月-2017 年2 月采用该术式进行一期假体植入乳房 再造23 例早期乳腺癌患者的临床资料，分析其手术特点以及手术适应证。结果 23 例早期乳腺癌患者均采用 该术式进行一期乳房再造。其中，1 例术后出现乳房局部皮肤变青紫，经过积极换药等对症处理后，逐渐恢复 正常，1 例小细胞型乳腺神经内分泌癌患者在术后6 个月，因乳腺癌肝转移而死亡。再造乳房形态良好，外观 自然，手感佳，瘢痕少，患者满意率高。结论 保留胸大肌筋膜的一期假体植入乳房再造手术相对安全简单， 美容效果好，并发症少，适用于早期乳腺癌的乳房再造。

Abstract:

Objective To explore the clinical value of breast reconstruction with prosthesis covered by a retrograde myofascial fascia combined with pectoralis major myocutaneous flap at the first stage of breast resectionin patients with early breast cancer. Methods The clinical date of 23 cases with early breast cancer were collected from June 2015 to Feb. 2017 in Hunan People's Hospital. The operation characteristics and surgical indications were analyzed. Results The one-stage breast reconstruction was performed in 23 cases with early breast cancer by modified mastectomy. Among them, 1 case had the local breast skin becomingpurple, and gradually returned by changing of dressing and symptomatic treatment; 1 case of small cell neuroendocrine carcinoma of the breast died of liver metastases in 6 months after surgery. Breast reconstruction was of good shape, natural appearance, good handle, little scar and high satisfaction rate. Conclusions Retaining pectoralis major fascia with one-stage prosthesis is relatively safe and simple, and is of satisfactory cosmetic results and few complications for breast reconstruction. which is suitable for breast reconstruction of early breast cancer.