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目的探讨前锯肌肌瓣联合假体植入在乳腺癌改良根治术后即刻乳房再造中的应用。方法 2015年1月—12月收治25例乳腺癌女性患者,年龄24~62岁,平均40.6岁。左侧9例,右侧16例。均为浸润性导管癌。TNM分期:Ⅰ期14例,ⅡA期11例。肿瘤位于乳房外上象限14例,上方7例,外下象限4例;均为单发肿块,肿块直径均<3 cm;无远处转移。前哨淋巴结均为阴性。改良根治术后,采用前锯肌肌瓣联合假体植入即刻再造乳房,其中22例保留乳头乳晕。结果手术时间113~148 min,平均136 min。术后再造乳房均全部成活,切口均Ⅰ期愈合,无血肿、感染等并发症发生。患者均获随访,随访时间6~18个月,平均15个月。除1例未随访达12个月外,其余患者术后12个月时参照再造乳房评价标准,获良23例、中1例。随访期间无肿瘤复发。结论乳腺癌改良根治术后采用前锯肌肌瓣联合假体植入即刻乳房再造,操作简便、损伤小、术后并发症少、再造乳房形态良好,患者满意度高。
Objective To investigate the application of anterior serratus muscle flap combined with prosthesis implantation in breast reconstruction immediately after modified radical mastectomy. Methods From January 2015 to December 2015, 25 women with breast cancer were enrolled, aged from 24 to 62 years (average 40.6 years). Left in 9 cases, right in 16 cases. All invasive ductal carcinoma. TNM staging: Ⅰ in 14 cases, Ⅱ A in 11 cases. The tumor was located in the upper quadrant of the upper breast in 14 cases, the upper 7 cases and the lower quadrant 4 cases. All of them were solitary tumors with tumor diameter <3 cm. There was no distant metastasis. Sentinel lymph nodes were negative. After modified radical mastectomy, the anterior serratus muscle flap and prosthesis were implanted to rebuild the breast immediately, of which 22 cases retained the nipple areola. Results The operation time ranged from 113 to 148 minutes with an average of 136 minutes. Postoperative reconstruction of breast all survived, incision healed, hematoma, infection and other complications. All patients were followed up for 6-18 months with an average of 15 months. In addition to 1 case did not visit up to 12 months, the remaining patients with reference to rebuild breast evaluation criteria 12 months after surgery, was good in 23 cases, 1 case. No tumor recurrence during follow-up. Conclusions Modified radical mastectomy combined with prosthesis implantation for immediate breast reconstruction after radical mastectomy for breast cancer is simple, less invasive and less postoperative complications. The shape of reconstructed breast is good and the patient satisfaction is high.