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目的探讨Ⅰ、Ⅱ期乳腺癌的个性化手术方案。方法回顾性分析2007年2月至2014年1月华中科技大学同济医学院附属同济医院整形外科收治的153例女性Ⅰ、Ⅱ期乳腺癌病人的临床资料,在病人保留乳房外形的要求下,行肿瘤切除或全乳切除+即刻乳房重建手术。结果 153例病人中,行保乳术+即刻乳房重建86例,包括带蒂远端腹直肌肌皮瓣乳房重建30例、带蒂背阔肌肌皮瓣乳房重建56例;保留皮肤的乳腺切除术+即刻乳房重建67例,包括带蒂远端腹直肌肌皮瓣乳房重建21例、带蒂背阔肌肌皮瓣及硅凝胶假体乳房重建43例、扩张器或假体乳房重建术3例。术后乳房形态优良率达93.5%。随访6~60个月,无局部复发及皮瓣坏死等严重并发症;5例发生脂肪液化,6例发生皮下血清肿,经换药引流后治愈;6例出现腹部隆起但无消化道症状;1例因脑转移死亡。结论即刻乳房重建是Ⅰ、Ⅱ期乳腺癌病人安全理想的选择,个性化的手术方案及带蒂皮瓣技术适合推广。
Objective To investigate the individualized surgical plans of stage Ⅰ and Ⅱ breast cancer. Methods The clinical data of 153 women with stage Ⅰ and Ⅱ breast cancer who underwent plastic surgery in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from February 2007 to January 2014 were retrospectively analyzed. Tumor resection or total mastectomy + immediate breast reconstruction surgery. Results Among the 153 patients, 86 cases underwent breast preservation surgery and immediate breast reconstruction, including 30 cases with pedicled distal rectus abdominis myocutaneous reconstruction and 56 cases with pedunculated latissimus dorsi myocutaneous flap; Resection + immediate breast reconstruction in 67 cases, including pedicled distal rectus abdominis myocutaneous reconstruction of breast in 21 cases, pedunculated latissimus dorsi muscle flap and silicone gel prosthesis reconstruction in 43 cases, dilator or prosthetic breast Reconstruction in 3 cases. Postoperative breast shape excellent rate of 93.5%. Follow-up 6 to 60 months, no local recurrence and serious necrosis of flaps necrosis; 5 cases of fat liquefaction, 6 cases of subcutaneous hematoma, after dressing drainage cure; 6 cases of abdominal bulge but no gastrointestinal symptoms; One died of brain metastases. Conclusions Immediate breast reconstruction is an ideal choice for patients with stage Ⅰ and Ⅱ breast cancer. Individualized surgical plans and pedicle flap techniques are suitable for promotion.