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目的探讨乳房切除后即刻假体乳房再造术中采用邻近组织覆盖假体的方法及近期疗效。方法回顾分析2014年4月-2015年8月乳房切除后采用即刻假体乳房再造术治疗的11例乳腺癌患者临床资料。患者年龄29~48岁,平均36岁。病程7 d~12个月,中位时间3个月。肿瘤分期:TisN0M0 3例,T1N0M0 4例,T2N0M0 4例。术中根据切除的乳腺组织体积以及对侧乳房形态选用合适假体,利用邻近组织覆盖假体,其中采用乳房下脂肪筋膜瓣联合胸大肌瓣3例,前锯肌筋膜瓣联合胸大肌瓣5例,腹直肌前鞘筋膜瓣联合胸大肌筋膜瓣1例,前锯肌筋膜瓣与腹直肌前鞘筋膜瓣联合胸大肌瓣2例。胸大肌瓣切取范围为15 cm×9 cm~20 cm×15 cm,前锯肌筋膜瓣切取范围为10 cm×8 cm~15 cm×10 cm,腹直肌前鞘筋膜瓣切取范围为8 cm×6 cm~10 cm×8 cm。结果术后除1例患者出现乳头部分缺血坏死外,其余患者切口均Ⅰ期愈合,未出现感染、出血等其他并发症。患者均获随访,随访时间4~13个月,中位时间8个月。末次随访时,根据乳房再造评价标准,获优10例、良1例,优良率100%。随访期间无假体破裂、渗漏以及假体形态外露,无明显排斥反应。1例出现BakerⅡ级包膜挛缩。结论乳房切除后即刻假体乳房再造术中,利用乳房邻近组织能对假体进行充分覆盖,并取得满意近期疗效。
Objective To investigate the short-term curative effect of using adjacent tissue to cover prostheses in breast implants immediately after mastectomy. Methods The clinical data of 11 patients with breast cancer treated with immediate prosthesis and mammary reconstruction after mastectomy from April 2014 to August 2015 were retrospectively analyzed. Patients aged 29 to 48 years, mean 36 years old. Duration of 7 d ~ 12 months, the median time of 3 months. Tumor stage: TisN0M0 3 cases, T1N0M0 4 cases, T2N0M0 4 cases. Surgery based on excised breast tissue volume and the contralateral breast shape selection of appropriate prosthesis, the use of adjacent tissue cover prosthesis, which uses the subcutaneous fat fascia flap combined with the large pectoralis major flap in 3 cases, the anterior saw muscle fascia flap combined with chest large 5 cases of muscle flap, anterior rectus fasciculus flap combined with pectoralis major fascia flap in 1 case, anterior serratus myofacial flap and anterior rectus fascia flap combined with pectoralis major muscle flap in 2 cases. The scope of pectoralis major muscle flap was 15 cm × 9 cm ~ 20 cm × 15 cm. The scope of the anterior fascia myofascial flap was 10 cm × 8 cm ~ 15 cm × 10 cm. It is 8 cm × 6 cm ~ 10 cm × 8 cm. Results All patients except one had avascular necrosis of the nipple after operation. All other incisions healed in the first phase without complications such as infection and hemorrhage. All patients were followed up for 4 to 13 months with a median time of 8 months. At the final follow-up, according to the criteria of breast reconstruction, 10 cases were excellent and 1 good, the excellent and good rate was 100%. During the follow-up period, there was no rupture of the prosthesis, leakage and the appearance of the prosthesis. There was no obvious rejection reaction. 1 case of Baker Ⅱ level capsule contracture. Conclusions In breast reconstruction immediately after mastectomy, the prosthesis can be fully covered by the adjacent tissue of the breast, and satisfactory short-term curative effect can be obtained.