摘要
目的探讨于不去皮的乳腺癌切除术后以扩张法为媒介行即刻分期乳房再造术，以简化手术操作方法．有利于放疗的进行。方法乳房再造分两期完成：Ⅰ期在乳房切除同时．于胸大肌后间隙置入圆形扩张器。并于术后4～12周扩张至满意体积；Ⅱ期手术取出扩张器后换置硅凝胶乳房假体．或行背阔肌肌皮瓣＋硅凝胶乳房假体置入。或单纯扩大背阔肌肌皮瓣转移．或单纯腹壁下动脉穿支（DIEP）皮瓣转移完成乳房再造。结果采用该技术进行即刻分期乳房再造术34例，平均完成乳房再造共需时间5．5个月。术后无假体外露、皮瓣坏死等并发症出现。术后随访6～18个月，患者对手术效果满意率97．1％。结论即刻分期乳房再造，简化了即刻Ⅰ期再造的手术难度，避免了术后放疗对乳房假体的影响。无需修补胸部皮肤缺损，因而避免了乳房表面的“补丁”样形象，是一项理想的即刻乳房再造方法。
Objective To present our experience in two-stage procedure immediate breast re construction, which aimed to retain local tissue condition for breast reconstruction, overcome the limitation of radiotherapy on implant reconstruction, and simplify the procedure as well as improve cosmetic result. Methods The proceduces of our method were divided into two stages： in the first stage, the round shaped expander was implanted in the subpeetoral major space during the procedure of mastectomy; at the same time as expander implanted, the first saline injection was performed; with 4 to 8 weeks of inflation, the tissue expander offered adequate tissue for breast reconstruction; in the second stage, silicon gel implant, latissimus dorsi muscle flap, extended latissimus dorsi muscle flap and deep inferior epigastic perforatior flap were used for breast reconstruction after the tissue expander was exchanged. Results Thirty-four patients had undergone the two-staged breast reconstruction using tis sue expansion. The average time of therapy was 5.5 months. There. were no postoperative complications such as implant exposure, additional scar, and flap necrosis. The follow-up time was 6 to 18 months and the result showed excellent contour of the breast at a satisfactory rate of 97.1 %. Conclusions Two staged technique using tissue expansion in breast reconstruction is easily done and the complications are rare. The technique possesses advantages such as avoiding affection of radiotherapy on silicongel implant and elasticity of skin, retaining maximal local tissue for breast reconstruction. There is no necessary for correction of skin defect and additional scarring, thus the patch-like appear ance of breast is avoided. The patients need not to experience depression post mastectomy. Two staged procedure immediate breast reconstruction is a safe and reliable technique that is especially applicable to the patients who need radiotherapy.
出处
《中华医学美学美容杂志》
2012年第6期416-419,共4页
Chinese Journal of Medical Aesthetics and Cosmetology
基金
资助项目：首部医学发展基金资助项目（编号：20093011）
作者简介
穆大力（Email：mudali@163．com）
通信作者：栾杰．Email：mudali@163．com
