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目的探讨背阔肌肌皮瓣在乳房重建术中的应用价值。方法回顾性分析2012年1月至2016年12月期间于笔者所在医院接受背阔肌肌皮瓣乳房重建的36例乳腺肿瘤患者的临床资料,总结术后并发症发生情况及建乳房的美容效果.结果 36例患者中,32例行一期乳房重建,4例行二期乳房重建,均行背阔肌肌皮瓣乳房重建。本组一期重建患者的手术时间为235-490 min(平均325 min),术中出血量为200~260 mL(平均220 mL),住院时间为18~33 d(平均23.6 d).二期重建患者两次手术的合计手术时间为325~550 min(平均355 min),合计术中出血量为200~250 mL(平均220 mL),合计住院时间为27~45 d(平均32.5 d)术后外观评价:优22例,良8例,一般6例,优良率达83.3%(30/36)术后皮瓣全部存活,发生供区血清肿21例,背部皮肤切缘部分坏死1例,乳头和乳晕表皮部分坏死2例一本组所有患者均获访,随访时间为3~60个月,中位随访时间为37个月随访期间,患者无局部复发和远处转移,2例患者接受放射治疗后重建乳房体积萎缩明显。所有患者的患肢功能均未受到明显影响。结论背阔肌肌皮瓣乳房重建是一种操作简便、并发症轻、易处理且效果良好的手术方法。
Objective To investigate the value of latissimus dorsi myocutaneous flap in breast reconstruction. Methods The clinical data of 36 breast tumor patients who underwent latissimus dorsi myocutaneous flap reconstruction in the author’s hospital from January 2012 to December 2016 were retrospectively analyzed. The incidence of postoperative complications and the cosmetic effect of breast reconstruction were summarized. Results Of the 36 patients, 32 underwent primary breast reconstruction and 4 underwent secondary breast reconstruction. All of them underwent latissimus dorsi myocutaneous flap reconstruction. The first-stage reconstructed patients in this group had operative time of 235-490 minutes (average 325 minutes), intraoperative blood loss of 200-260 mL (average 220 mL), and hospitalization time of 18-33 days (mean 23.6 days). The total operation time for reconstructive surgery was 325 to 550 minutes (average 355 minutes). The total intraoperative blood loss was 200 to 250 mL (average 220 mL). The total length of hospital stay was 27 to 45 days (average 32.5 days). After appearance evaluation: excellent in 22 cases, good in 8 cases, general in 6 cases, excellent rate of 83.3% (30/36) after the flaps all survived, 21 cases of donor site seroma occurred, and 1 case of necrosis at the margin of the back skin. Partial necrosis of the nipple and areola in the epidermis was achieved in 2 patients and all patients in this group were followed up for 3 to 60 months. During a median follow-up of 37 months, no local recurrence and distant metastasis occurred. Two patients received Reconstructed breast volume shrinks significantly after radiation therapy. All patients’ limb function was not significantly affected. Conclusion The latissimus dorsi myocutaneous flap reconstruction is a simple surgical procedure with simple complications, easy treatment and good effect.