中国普外基础与临床杂志

中国普外基础与临床杂志

假体在即刻乳房重建术中的应用

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目的 探讨假体在即刻乳房重建术中的应用价值。 方法 回顾性分析 2012 年 1 月至 2017 年 6 月期间于笔者所在医院接受即刻假体乳房重建的 42 例乳腺肿瘤患者的临床资料(其中有 6 例乳腺恶性叶状肿瘤患者),总结术后重建乳房的美容效果及并发症发生情况。 结果 本组患者的手术顺利,手术时间为 230~435 min(平均 325 min),术中出血量为 100~160 mL(平均 130 mL),住院时间为 18~33 d(平均 24 d)。术后外观评价:优 26 例,良 8 例,差 8 例,优良率为 81.0%(34/42);患者对重建乳房的总体满意度为 73.8%(31/42),美学满意度为 78.6%(33/42)。术后出现血清肿 2 例,3 例乳头乳晕部分皮肤发生缺血坏死。本组所有患者均获访,随访时间为 4~70 个月,中位随访时间为 37 个月。随访期间,患者无局部复发和远处转移发生;6 例接受了放射治疗的患者中有 2 例出现Ⅱ度包膜挛缩。 结论 即刻假体乳房重建术是一种操作简便、并发症轻、易处理且效果良好的手术方法。

Objective To evaluate the feasibility of immediate breast reconstruction with silicone prosthesis for breast tumor. Methods The clinical data of the 42 patients with breast tumor who had undergone breast reconstruction with silicone prosthesis from January 2012 to June 2017 were collected retrospectively. The postoperative complications and cosmetic results were analyzed. Results All patients underwent operation successfully. The surgical time was 230–435 min (mean of 325 min), the intraoperative blood loss was 100–160 mL (mean of 130 mL), and the hospitalization time was 18–33 d (mean of 24 d). The cosmetic results was excellent in 26 patients, good in 8 patients, bad in 8 patients, and fine rate was 81.0% (34/42). Rate of patients’ overall satisfaction with breast reconstruction was 73.8% (31/42) and rate of aesthetic satisfaction was 78.6% (33/42). After operation, seroma occurred in 2 patients, and the ischemic necrosis in nipple and areola occurred in 3 patients. All the patients were followed-up for 4–70 months, and the median follow-up time was 37 months. During the follow-up period, no patient had metastasis or recurrence. Six patients received radiotherapy, among them 2 patients appeared Ⅱ-grade capsular contracture. Conclusion The breast reconstruction with silicone prosthesis is a simple, easy, and effective surgical procedure.

关键词: 乳腺肿瘤; 假体; 即刻乳房重建

Key words: breast tumor; silicon prosthesis; immediate breast reconstruction

引用本文: 冯跃庆, 周勇, 张志敏. 假体在即刻乳房重建术中的应用. 中国普外基础与临床杂志, 2018, 25(10): 1206-1212. doi: 10.7507/1007-9424.201805097 复制

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1. 邵志敏, 余科达. 乳腺外科的发展趋势. 中国普外基础与临床杂志, 2007, 14(3): 252-254.
2. 江泽飞, 李健斌. 精准医学时代乳腺外科十个热点问题思考. 中华普外科手术学杂志: 电子版, 2016, 10(3): 192-196.
3. Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in U.S. breast reconstruction: increasing implant rates. Plast Reconstr Surg, 2013, 131(1): 15-23.
4. Jagsi R, Jiang J, Momoh AO, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol, 2014, 32(9): 919-926.
5. Hernandez-Boussard T, Zeidler K, Barzin A, et al. Breast reconstruction national trends and healthcare implications. Breast J, 2013, 19(5): 463-469.
6. 共识专家讨论组. 保留乳头乳晕复合体乳房切除术的专家共识与争议 (2015年版). 中国癌症杂志, 2016, 26(5): 476-479.
7. Munhoz AM, Montag E, Filassi JR, et al. Immediate nipple-areola-sparing mastectomy reconstruction: an update on oncological and reconstruction techniques. World J Clin Oncol, 2014, 5(3): 478-494.
8. Wei FC, Mardini S, Allen RJ, 等著; 孙家明, 王巍, 熊凌云, 等译. 皮瓣与重建外科. 北京: 人民卫生出版, 2011: 158-160.
9. 高德宗, 张强, 李亮, 等. Ⅰ期假体植入乳房再造在保留乳头乳腺癌改良根治术中的临床应用. 山东大学学报: 医学版, 2010, 48(4): 106-108, 112.
10. 刘静, 张学慧, 孙敬岩, 等. 腹壁下穿支皮瓣乳房重建的满意度及并发症. 中华医学美学美容杂志, 2016, 22(3): 160-164.
11. 吴炅. 肿瘤整形技术在乳腺癌治疗中的应用. 临床外科杂志, 2016, 24(9): 660-662.
12. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范 (2015 版). 中国癌症杂志, 2015, 25(9): 692-754.
13. 中华医学会整形外科学分会乳腺专业学组. 乳腺癌切除术后乳房再造临床指南. 中华肿瘤杂志, 2014, 36(11): 851-857.
14. Quinn TT, Miller GS, Rostek M, et al. Prosthetic breast reconstruction: indications and update. Gland Surg, 2016, 5(2): 174-186.
15. 何英, 邓宏武, 万能斌, 等. 现代医学模式影响下的乳腺癌手术方式递嬗. 医学与哲学, 2017, 38(8): 27-30.
16. 陈颖, 陈嘉健, 陈嘉莹, 等. 中国乳腺癌术后乳房重建现况调查报告. 中华肿瘤杂志, 2014, 36(11): 851-857.
17. Momoh AO, Ahmed R, Kelley BP, et al. A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy. Ann Surg Oncol, 2014, 21(1): 118-124.
18. Kronowitz SJ. Current status of implant-based breast reconstruction in patients receiving postmastectomy radiation therapy. Plast Reconstr Surg, 2012, 130(4): 513e-523e.
19. Dalberg K, Krawiec K, Sandelin K. Eleven-year follow-up of a randomized study of pectoral fascia preservation after mastectomy for early breast cancer. World J Surg, 2010, 34(11): 2539-2544.
20. Dalberg K, Johansson H, Signomklao T, et al. A randomised study of axillary drainage and pectoral fascia preservation after mastectomy for breast cancer. Eur J Surg Oncol, 2004, 30(6): 602-609.
21. Sandelin K, Wickman M, Billgren AM. Oncological outcome after immediate breast reconstruction for invasive breast cancer: a long-term study. Breast, 2004, 13(3): 210-218.
22. Fitoussi A, Berry MG, Couturad B, 等著; 张斌, 曹旭晨, 常新忠, 等译. 乳腺肿瘤整形与重建手术图谱. 北京: 人民卫生出版社, 2011: 41-42.
23. Grotting JC, Allen RJ, Andrews A, 等著; 范巨峰, 江华, 李洪生, 等译. 麦卡锡整形外科学 (第五分卷): 乳房. 第3版. 北京: 人民卫生出版社, 2015: 303-306.
24. Spiegel AJ. Breast reconstruction-current perspectives and state of the art techniques. Rijeka: InTech, 2013: 40-41.
25. Ahn S, Kim I, Kim J, 等著; 金光逸, 张晨, 王洁晴, 等译. 现代韩国乳房整形术. 沈阳: 辽宁科学技术出版社, 2016: 126-129.
26. 路选, 陈飞, 高小康. 双平面假体置入在乳腺癌术后Ⅰ期再造中的应用. 中国美容整形外科杂志, 2014, 25(8): 478-479.
27. Saint-Cyr M, Nagarkar P, Wong C, et al. The pedicled subpectoral fascia flap for expander coverage in postmastectomy breast reconstruction: a novel technique. Plast Reconstr Surg, 2010, 125(5): 1328-1334.
28. Jinde L, Jianliang S, Xiaoping C, et al. Anatomy and clinical significance of pectoral fascia. Plast Reconstr Surg, 2006, 118(7): 1557-1560.
29. Stecco A, Masiero S, Macchi V, et al. The pectoral fascia: anatomical and histological study. J Bodyw Mov Ther, 2009, 13(3): 255-261.