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目的探讨乳腺癌根治术后即时乳房再造的肿瘤治疗和形体完美双重效果。方法对1999年1月至2005年7月病理证实为乳腺癌的150例患者[均为女性,年龄49±15岁,肿瘤大小(1.6±1.2)cm,腋窝未及淋巴结]行乳腺全切除(包括传统改良根治11例,保留乳房皮肤的改良根治12例,保留乳头、乳晕的改良根治127例)后,即时行乳房再造[I期背阔肌皮瓣再造139例,下腹横形腹直肌皮瓣(TRAM)再造11例]。结果手术成功149例,失败1例(损伤血管),术后并发腹壁疝1例,乳房出现脂肪结节6例,脂肪液化3例,腹部切口延迟愈合3例,背部血肿28例,切口边缘局部皮肤坏死7例,移植物缺血坏死1例(再次手术切除),乳头坏死4例。本组随访到123例,随访率82%,平均随访时间36.6月,发生腋窝淋巴结转移2例,骨转移1例,锁骨上淋巴结转移1例,死亡1例(因转移自杀),无局部复发,术后外形改变(按JCRT标准):优、良、中、差分别为11.5%、49.3%、36.7%、2.6%。结论乳腺癌根治术后即时乳房再造联合辅助治疗对早中期乳腺癌是可行的,能达到治疗和美容效果。
Objective To investigate the dual effect of immediate breast reconstruction and tumor treatment after breast cancer radical surgery. Methods 150 patients (all women, age 49 ± 15 years, tumor size (1.6 ± 1.2) cm, axillary lymph nodes] who had pathologically confirmed breast cancer from January 1999 to July 2005 underwent total mastectomy Including the traditional modified radical mastectomy in 11 cases, retained the modified radical mastectomy of the skin in 12 cases, retained the nipple, areola modified radical mastectomy 127 cases) immediately after breast reconstruction [I period latissimus dorsi flap reconstruction in 139 cases, (TRAM) reconstruction in 11 cases]. Results The operation was successful in 149 cases, failure in 1 case (vascular injury), abdominal wall hernia in 1 case, breast fat nodules in 6 cases, fat liquefaction in 3 cases, delayed incision in 3 cases, back hematoma in 28 cases, 7 cases of skin necrosis, 1 case of graft necrosis (resection again), 4 cases of nipple necrosis. This group was followed up to 123 cases, with a follow-up rate of 82% and an average follow-up time of 36.6 months. There were 2 cases of axillary lymph node metastasis, 1 case of bone metastasis, 1 case of supraclavicular lymph node metastasis and 1 case of death due to suicide. Postoperative changes in shape (according to JCRT standards): excellent, good, moderate and poor were 11.5%, 49.3%, 36.7%, 2.6%. Conclusion Immediate breast reconstruction combined with adjuvant therapy after radical mastectomy is feasible for early-stage breast cancer and can achieve therapeutic and cosmetic effects.