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背景:近年来乳腺肿块的检出率较以前明显增加,采用何种术式不仅关系到患者术后是否复发,还关系到她们术后自信心重建的问题。所以,最大限度的减少患者生理和心理上的创伤应该成为外科医生选择术式的首要因素。目的:观察保留乳房皮肤的乳腺切除后应用腹直肌肌皮瓣、背阔肌肌皮瓣加乳房假体、局部皮瓣与单纯乳房假体4种方式即刻再造乳房的效果。设计:病例分析。单位:暨南大学医学院第二临床医学院,深圳市人民医院整形外科。对象:15例患乳腺导管内原位癌和巨大乳腺良性肿瘤患者为深圳市人民医院1997-10/2004-05收治,年龄20～46岁,均为单侧乳房患病。其中8例为乳腺导管内原位癌,T1N0M0,7例为巨大乳腺良性肿瘤。所有手术术前均向患者告知手术方案,征得患者同意。方法:采用保留乳房皮肤的乳晕环形切口行乳腺或巨大肿瘤的乳房皮下切除术,应用腹直肌肌皮瓣、背阔肌肌皮瓣加乳房假体、局部皮瓣与单纯乳房假体4种不同术式行即刻再造乳房,充填乳房的内容,肌皮瓣再造时仅以少量的肌皮瓣皮肤弥补切除后的乳头乳晕部位。再次手术时在该转移的皮瓣上再造乳头。主要观察指标:观察术后患者有无复发或转移,伤口局部愈合情况。结果:经多专科协作完成15例手术,14例随访时间1年以上,无肿瘤复发。再造乳房与健侧乳房对称,保留了原有乳房皮肤的感觉,外观形态自然,瘢痕较少且隐蔽。结论:在严格手术适应证防止乳腺癌复发的前提下,此法为一较完善的乳腺切除与乳房再造方法。
Background: In recent years, the detection rate of breast lumps has increased significantly compared with the previous ones. What kind of surgical procedures are used depends not only on whether the patients relapse after surgery, but also on the postoperative self-confidence reconstruction. Therefore, to minimize physical and psychological trauma to patients should be the primary factor in surgical selection of surgeons. OBJECTIVE: To observe the effect of breast reconstruction immediately after breast excision with 4 ways of rectus abdominis myocutaneous flap, latissimus dorsi myocutaneous flap plus breast prosthesis, local flap and simple breast prosthesis. Design: Case Analysis. Unit: Second Clinical Medical College, Jinan University, Shenzhen People ’s Hospital, Department of Plastic Surgery. PARTICIPANTS: Fifteen patients with intraductal carcinoma in situ and giant benign breast tumor were admitted to Shenzhen People’s Hospital from October 1997 to May 2004, aged from 20 to 46 years old, all of whom had unilateral breast disease. Among them, 8 cases were ductal carcinoma in situ, 7 cases of T1N0M0 were giant benign breast tumors. All patients were informed of surgical procedures before surgery, patients consent. Methods: Breast subcutaneous excision of the mammary gland or giant tumor was performed with a circular incision which preserved the skin of the breast. Mammary flap with the rectus abdominis flap, latissimus dorsi muscle flap with breast prosthesis, partial flap and simple breast prosthesis Different surgical procedures to rebuild the breast immediately, filling the contents of the breast, myocutaneous flap reconstruction with only a small amount of myocutaneous skin to make up after removal of the nipple areola parts. Re-implant the nipple on the diverting flap upon further surgery. MAIN OUTCOME MEASURES: The postoperative patients were observed whether recurrence or metastasis, wound healing. Results: Fifteen cases were completed by multidisciplinary collaboration and 14 cases were followed up for more than one year without tumor recurrence. Reconstruction of the breast and the contralateral breast symmetry, leaving the original feeling of the skin of the breast, the appearance of natural morphology, less scar and hidden. Conclusion: Under the premise of strict surgical indications to prevent the recurrence of breast cancer, this method is a more complete mastectomy and breast reconstruction methods.