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目的总结采用乳房整形技术对早期乳腺癌患者进行保乳手术治疗的临床经验和术后美容效果。方法 2007年1月至2011年3月期间我院收治的手术方式为保乳手术的乳腺癌患者136例,其中59例在保乳手术时采用了乳房整形技术,回顾性分析该59例患者的临床资料,并采用体检测量和满意度调查表的方式对手术后乳房的美容效果进行评价。结果患者均为女性,年龄(53.5±9.8)岁,32~77岁。肿瘤直径为(1.6±0.7)cm,0.5~4.0 cm。肿瘤位于上象限38例,下象限17例,中央区4例。手术切口采用单切口25例,双切口34例。切除肿瘤后乳腺缺损修复方法有:残留腺体直接缝合法9例,乳腺组织腺蒂瓣转位法35例,局部皮瓣或脂肪筋膜瓣转移法9例,“J”形或双环缩乳法4例,背阔肌肌瓣法2例。随访3~53个月,平均30个月,未发现局部和区域淋巴结肿瘤复发;术后14个月发生骨转移1例;无伤口、皮肤坏死和感染。未发现死亡病例。乳房美容总评分大于26分者53例,优良率为89.8%(53/59)。手术后乳房美容满意度调查显示,非常满意40例(67.8%),满意14例(23.7%),一般3例(5.1%),不满意2例(3.4%),无非常不满意患者。结论选择合适的早期乳腺癌患者采用乳房整形技术进行保乳手术治疗,安全、有效,术后患者对乳房外形及整体美容效果满意度高,是值得推荐的一种技术。
Objective To summarize the clinical experiences and postoperative cosmetic results of breast conserving surgery treated with breast plastic surgery. Methods From January 2007 to March 2011, 136 cases of breast cancer patients undergoing breast-conserving operation were treated in our hospital. Among them, 59 cases underwent breast-conserving surgery during breast-conserving surgery. Retrospective analysis of the 59 patients Clinical data, and the use of physical examination measurement and satisfaction questionnaire on the cosmetic effect of postoperative breast evaluation. Results All patients were female, age (53.5 ± 9.8) years old, 32 to 77 years old. Tumor diameter was (1.6 ± 0.7) cm, 0.5 ~ 4.0 cm. Tumor located in the upper quadrant of 38 cases, the lower quadrant in 17 cases, the central region in 4 cases. Surgical incision with a single incision in 25 cases, double incision in 34 cases. Nineteen cases of mammary gland defect repair after tumor resection were directly sutured by residual gland, 35 cases of mammary glandular flap flap transposition, 9 cases of local flap or fatty fascia flap transfer, 9 cases of “J” shape or double ring 4 cases of deflation method and 2 cases of latus latissimus dorsi muscle flap. All the patients were followed up for 3 ~ 53 months with an average of 30 months. No local or regional lymph node tumor recurrence was observed. One case had bone metastasis at 14 months after operation. No wounds, skin necrosis and infection were found. No deaths were found. In total, breast beautification score was more than 26 points in 53 cases, the excellent and good rate was 89.8% (53/59). Surgical breast cosmetic satisfaction survey showed that 40 patients (67.8%) were satisfied, 14 (23.7%) were satisfied, 3 (5.1%) were generally unsatisfied, and 2 (3.4%) were not satisfied. Conclusion It is a recommendable technique to select appropriate breast cancer patients for breast-conserving surgery with breast plastic surgery, which is safe, effective and satisfactory to postoperative breast shape and overall cosmetic effect.