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目的:探讨保留乳头乳晕复合体(NAC)的乳腺癌改良根治术后应用侧胸壁脂肪筋膜肌肉瓣即刻乳房成形的适应证、疗效及可行性。方法:对43例扁平或小乳房、IIIA期前的乳腺癌患者行保留NAC的乳腺癌改良根治术,术中即刻应用侧胸壁脂肪筋膜肌肉瓣乳房成形或同时联合假体乳房重建,术后评价美容效果,观察并发症,对治疗效果进行随访。结果:43例患者均成功手术。平均手术时间1.7(1.3~2.2)h,平均住院时间17(13~24)d,术后平均住院时间13(10~18)d。术后随访2~12个月,无乳头坏死,组织瓣感染2例;无局部复发及远处转移;患者总体满意度8.5分,乳房外观客观评价良好率86.0%(37/43)。结论:保留NAC的乳腺癌改良根治术后即刻应用侧胸壁脂肪筋膜肌肉瓣修复重塑乳房外形具有操作方便、手术快捷、技术可行的特点,特别适合于扁平小乳房、IIIA期前的乳腺癌患者。
Objective: To investigate the indications, curative effects and feasibility of applying immediate breast reconstruction of the side wall muscle fascia of the breast after modified radical mastectomy with preserved nipple areola complex (NAC). Methods: 43 cases of breast cancer with flat or small breast and before stage IIIA were treated with modified radical mastectomy with NAC preserved. The intrathoracic fat fascia and muscle flap were implanted immediately or simultaneously with reconstruction of breast prosthesis. Evaluation of cosmetic results, observe the complications, follow-up of the treatment effect. Results: All 43 patients underwent successful surgery. The average operation time was 1.7 (1.3 ~ 2.2) h, the average hospitalization time was 17 (13 ~ 24) days and the average postoperative hospital stay was 13 (10 ~ 18) days. The patients were followed up for 2 to 12 months without papillary necrosis and tissue flap infection in 2 cases. No local recurrence and distant metastasis were found. The overall satisfaction of the patients was 8.5 and the good objective evaluation of breast appearance was 86.0% (37/43). Conclusion: NAM-modified breast cancer modified radical mastectomy immediately after the application of the side wall of the fascia muscle flap repair remodeling breast shape has the characteristics of easy operation, quick operation and technical feasibility, especially for flat small breasts, pre-IIIA breast cancer patient.