• 深圳市第二人民醫(yī)院乳腺疾病診療中心(廣東深圳518035);

目的探討保留皮膚的乳腺癌改良根治術(shù)后即刻乳房假體再造的臨床應(yīng)用價(jià)值。方法我院2006年1月至2009年12月期間收治的28例乳腺癌患者行保留皮膚的乳腺癌改良根治術(shù)后，同時(shí)于胸大肌后置入硅膠假體再造乳房，對(duì)圍手術(shù)期結(jié)果、乳房外觀評(píng)價(jià)以及隨訪結(jié)果進(jìn)行分析。結(jié)果本組28例患者均行腋窩淋巴結(jié)清掃術(shù)，清除淋巴結(jié)數(shù)目為14～32枚，中位數(shù)為21枚。手術(shù)時(shí)間為117~140 min (平均126 min)，術(shù)中出血量為82~124 ml (平均98 ml)，術(shù)后引流管拔除時(shí)間為3~5 d。所有患者術(shù)后均無(wú)傷口積液、感染、皮膚壞死、異物反應(yīng)等，22例保留了乳頭乳暈復(fù)合體的患者均無(wú)乳頭乳暈缺血、壞死?；颊咝g(shù)后乳房外觀評(píng)價(jià)中，10例為優(yōu)，18例為良，優(yōu)良率為100%。所有患者術(shù)后均獲隨訪，隨訪時(shí)間為12～48個(gè)月(中位隨訪時(shí)間24個(gè)月)，未發(fā)現(xiàn)有遠(yuǎn)處轉(zhuǎn)移和局部復(fù)發(fā)，無(wú)上肢水腫及功能障礙。所有患者乳房外觀及手感滿(mǎn)意，無(wú)纖維包膜攣縮。結(jié)論保留皮膚的乳腺癌改良根治術(shù)后用硅膠假體行即刻乳房再造具有創(chuàng)傷小、安全、手術(shù)操作簡(jiǎn)單、術(shù)后恢復(fù)快的特點(diǎn)，再造后乳房美觀，效果滿(mǎn)意，值得臨床推廣。

引用本文： 陳偉財(cái),王先明,王敏,吳恢升,何勁松. 保留皮膚的乳腺癌改良根治術(shù)后即刻乳房假體再造的臨床應(yīng)用. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(9): 956-960. doi: 復(fù)制

1. 張欣, 張蒲容, 陳潔, 等. 關(guān)于女性乳腺疾病患者對(duì)保乳及乳房重建認(rèn)同度的調(diào)查 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(12): 12401244.
2. 蔣宏傳, 李發(fā)成, 李杰. 保留皮膚的乳腺癌改良根治術(shù)后即刻假體植入再造乳房的探討[J]. 中國(guó)實(shí)用外科雜志, 2005, 25(2): 8485.
3. Toth BA, Forley BG, Calabria R. Retrospective study of the skinsparing mastectomy in breast reconstruction [J]. Plast Reconstr Surg, 1999, 104(1): 7784.
4. 喬群, 孫家明. 乳房整形美容外科學(xué) [M]. 鄭州: 鄭州大學(xué)出版社, 2004: 182186.
5. 左文述. 現(xiàn)代乳腺腫瘤學(xué) [M]. 第2版. 濟(jì)南: 山東科學(xué)技術(shù)出版社, 1996: 12401241.
6. 穆蘭花, 辛敏強(qiáng), 欒杰, 等. 即刻乳房再造的并發(fā)癥及處理原則 [J]. 中國(guó)實(shí)用外科雜志, 2008, 28(7): 587588.
7. 劉金香. 早期按摩預(yù)防假體隆乳術(shù)后包膜囊硬化98例 [J]. 中華醫(yī)學(xué)美學(xué)美容雜志, 2002, 8(2): 108.
8. 蔣宏傳, 李發(fā)成, 王克有, 等. 乳腺癌改良根治術(shù)與乳房即時(shí)再造 [J]. 中國(guó)微創(chuàng)外科雜志, 2004, 4(5): 390391,394.
9. Fersis N, Hoenig A, Relakis K, et al. Skinsparing mastectomy and immediate breast reconstruction:incidence of recurrence in patients with invasive breast cancer [J]. Breast, 2004, 13(6): 488493.
10. Simmons RM, Fish SK, Gayle L, et al. Local and distant recurrence rates in skinsparing mastectomies compared with nonskinsparing mastectomies [J]. Ann Surg Oncol, 1999, 6(7): 676681.
11. Rivadeneira DE, Simmons RM, Fish SK, et al. Skinsparing mastectomy with immediate breast reconstruction: a critical analysis of local recurrence [J]. Cancer J, 2000, 6(5): 331335.
12. 高海燕, 朱玉蘭, 周曉云. 乳腺癌保留乳頭改良根治術(shù)同期假體植入乳房再造術(shù) [J]. 實(shí)用臨床醫(yī)藥雜志, 2008, 12(9): 6364.
13. 王穎, 張學(xué)慧, 亓發(fā)芝. 保留皮膚的乳腺癌改良根治術(shù)后即刻乳房再造的臨床應(yīng)用 [J/CD]. 中華乳腺病雜志(電子版), 2008, 2(3): 279288.
14. 邵志敏, 余科達(dá). 乳腺外科的發(fā)展趨勢(shì) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007, 14(3): 252254.
15. Chagpar A, Langstein HN, Kronowitz SJ, et al. Treatment and outcome of patients with chest wall recurrence after mastectomy and breast reconstruction [J]. Am J Surg, 2004, 187(2): 164169.
16. Langstein HN, Cheng MH, Singletary SE, et al. Breast cancer recurrence after immediate reconstruction:patterns and significance [J]. Plast Reconstr Surg, 2003, 111(2): 712720.
17. Murphy RX, Wahhab S, Rovito PF, et al. Impact of immediate reconstruction on the local recurrence of breast cancer after mastectomy [J]. Ann Plast Surg, 2003, 50(4): 333338.
18. Garwood ER, Moore D, Ewing C, et al. Total skinsparing mastectomy: complications and local recurrence rates in 2 cohorts of patients [J]. Ann Surg, 2009, 249(1): 2632.
19. 吳祥德, 董守義. 乳腺疾病診治 [M]. 第2版. 北京: 人民衛(wèi)生出版社, 2009: 404411.
20. 蔣宏傳, 苗蕊. 乳腺癌術(shù)后乳房重建進(jìn)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(12): 12211224.
21. Birdsell DC, Jenkins H, Berkel H. Breast cancer diagnosis and survival in women with and without breast implants [J]. Plast Reconstr Surg, 1993, 92(5): 795800.
22. Cronin TD, Gerow FJ. Augmentation mammaplasty: A new “natural feel” prosthesis [C]. Trans Third Int Congr Plastic Surgeons. New York: Excerpta Medica, 1963: 4149.
23. Ahmed S, Snelling A, Bains M, et al. Breast reconstruction [J]. BMJ, 2005, 330(7497): 943948.
24. Cicchetti S, Leone MS, Franchelli S, et al. Onestage breast reconstruction using McGhan Style 150 biodimensional expanders: a review of 107 implants with six years experience [J]. J Plast Reconstr Aesthet Surg, 2006, 59(10): 10371042.
25. 朱毓平. 乳腺癌改良根治術(shù)后一期乳房假體再造乳房的討論 [J]. 中國(guó)現(xiàn)代醫(yī)學(xué)雜志, 2008, 18(22): 33273328, 3331.
  1. 1. 張欣, 張蒲容, 陳潔, 等. 關(guān)于女性乳腺疾病患者對(duì)保乳及乳房重建認(rèn)同度的調(diào)查 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(12): 12401244.
  2. 2. 蔣宏傳, 李發(fā)成, 李杰. 保留皮膚的乳腺癌改良根治術(shù)后即刻假體植入再造乳房的探討[J]. 中國(guó)實(shí)用外科雜志, 2005, 25(2): 8485.
  3. 3. Toth BA, Forley BG, Calabria R. Retrospective study of the skinsparing mastectomy in breast reconstruction [J]. Plast Reconstr Surg, 1999, 104(1): 7784.
  4. 4. 喬群, 孫家明. 乳房整形美容外科學(xué) [M]. 鄭州: 鄭州大學(xué)出版社, 2004: 182186.
  5. 5. 左文述. 現(xiàn)代乳腺腫瘤學(xué) [M]. 第2版. 濟(jì)南: 山東科學(xué)技術(shù)出版社, 1996: 12401241.
  6. 6. 穆蘭花, 辛敏強(qiáng), 欒杰, 等. 即刻乳房再造的并發(fā)癥及處理原則 [J]. 中國(guó)實(shí)用外科雜志, 2008, 28(7): 587588.
  7. 7. 劉金香. 早期按摩預(yù)防假體隆乳術(shù)后包膜囊硬化98例 [J]. 中華醫(yī)學(xué)美學(xué)美容雜志, 2002, 8(2): 108.
  8. 8. 蔣宏傳, 李發(fā)成, 王克有, 等. 乳腺癌改良根治術(shù)與乳房即時(shí)再造 [J]. 中國(guó)微創(chuàng)外科雜志, 2004, 4(5): 390391,394.
  9. 9. Fersis N, Hoenig A, Relakis K, et al. Skinsparing mastectomy and immediate breast reconstruction:incidence of recurrence in patients with invasive breast cancer [J]. Breast, 2004, 13(6): 488493.
  10. 10. Simmons RM, Fish SK, Gayle L, et al. Local and distant recurrence rates in skinsparing mastectomies compared with nonskinsparing mastectomies [J]. Ann Surg Oncol, 1999, 6(7): 676681.
  11. 11. Rivadeneira DE, Simmons RM, Fish SK, et al. Skinsparing mastectomy with immediate breast reconstruction: a critical analysis of local recurrence [J]. Cancer J, 2000, 6(5): 331335.
  12. 12. 高海燕, 朱玉蘭, 周曉云. 乳腺癌保留乳頭改良根治術(shù)同期假體植入乳房再造術(shù) [J]. 實(shí)用臨床醫(yī)藥雜志, 2008, 12(9): 6364.
  13. 13. 王穎, 張學(xué)慧, 亓發(fā)芝. 保留皮膚的乳腺癌改良根治術(shù)后即刻乳房再造的臨床應(yīng)用 [J/CD]. 中華乳腺病雜志(電子版), 2008, 2(3): 279288.
  14. 14. 邵志敏, 余科達(dá). 乳腺外科的發(fā)展趨勢(shì) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007, 14(3): 252254.
  15. 15. Chagpar A, Langstein HN, Kronowitz SJ, et al. Treatment and outcome of patients with chest wall recurrence after mastectomy and breast reconstruction [J]. Am J Surg, 2004, 187(2): 164169.
  16. 16. Langstein HN, Cheng MH, Singletary SE, et al. Breast cancer recurrence after immediate reconstruction:patterns and significance [J]. Plast Reconstr Surg, 2003, 111(2): 712720.
  17. 17. Murphy RX, Wahhab S, Rovito PF, et al. Impact of immediate reconstruction on the local recurrence of breast cancer after mastectomy [J]. Ann Plast Surg, 2003, 50(4): 333338.
  18. 18. Garwood ER, Moore D, Ewing C, et al. Total skinsparing mastectomy: complications and local recurrence rates in 2 cohorts of patients [J]. Ann Surg, 2009, 249(1): 2632.
  19. 19. 吳祥德, 董守義. 乳腺疾病診治 [M]. 第2版. 北京: 人民衛(wèi)生出版社, 2009: 404411.
  20. 20. 蔣宏傳, 苗蕊. 乳腺癌術(shù)后乳房重建進(jìn)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(12): 12211224.
  21. 21. Birdsell DC, Jenkins H, Berkel H. Breast cancer diagnosis and survival in women with and without breast implants [J]. Plast Reconstr Surg, 1993, 92(5): 795800.
  22. 22. Cronin TD, Gerow FJ. Augmentation mammaplasty: A new “natural feel” prosthesis [C]. Trans Third Int Congr Plastic Surgeons. New York: Excerpta Medica, 1963: 4149.
  23. 23. Ahmed S, Snelling A, Bains M, et al. Breast reconstruction [J]. BMJ, 2005, 330(7497): 943948.
  24. 24. Cicchetti S, Leone MS, Franchelli S, et al. Onestage breast reconstruction using McGhan Style 150 biodimensional expanders: a review of 107 implants with six years experience [J]. J Plast Reconstr Aesthet Surg, 2006, 59(10): 10371042.
  25. 25. 朱毓平. 乳腺癌改良根治術(shù)后一期乳房假體再造乳房的討論 [J]. 中國(guó)現(xiàn)代醫(yī)學(xué)雜志, 2008, 18(22): 33273328, 3331.