• 深圳市第二人民醫(yī)院乳腺疾病診療中心(廣東深圳518035);

目的探討保留皮膚的乳腺癌改良根治術后即刻乳房假體再造的臨床應用價值。方法我院2006年1月至2009年12月期間收治的28例乳腺癌患者行保留皮膚的乳腺癌改良根治術后,同時于胸大肌后置入硅膠假體再造乳房,對圍手術期結果、乳房外觀評價以及隨訪結果進行分析。結果本組28例患者均行腋窩淋巴結清掃術,清除淋巴結數(shù)目為14~32枚,中位數(shù)為21枚。手術時間為117~140 min (平均126 min),術中出血量為82~124 ml (平均98 ml),術后引流管拔除時間為3~5 d。所有患者術后均無傷口積液、感染、皮膚壞死、異物反應等,22例保留了乳頭乳暈復合體的患者均無乳頭乳暈缺血、壞死?;颊咝g后乳房外觀評價中,10例為優(yōu),18例為良,優(yōu)良率為100%。所有患者術后均獲隨訪,隨訪時間為12~48個月(中位隨訪時間24個月),未發(fā)現(xiàn)有遠處轉(zhuǎn)移和局部復發(fā),無上肢水腫及功能障礙。所有患者乳房外觀及手感滿意,無纖維包膜攣縮。結論保留皮膚的乳腺癌改良根治術后用硅膠假體行即刻乳房再造具有創(chuàng)傷小、安全、手術操作簡單、術后恢復快的特點,再造后乳房美觀,效果滿意,值得臨床推廣。

引用本文: 陳偉財,王先明,王敏,吳恢升,何勁松. 保留皮膚的乳腺癌改良根治術后即刻乳房假體再造的臨床應用. 中國普外基礎與臨床雜志, 2011, 18(9): 956-960. doi: 復制

1. 張欣, 張蒲容, 陳潔, 等. 關于女性乳腺疾病患者對保乳及乳房重建認同度的調(diào)查 [J]. 中國普外基礎與臨床雜志, 2010, 17(12): 12401244.
2. 蔣宏傳, 李發(fā)成, 李杰. 保留皮膚的乳腺癌改良根治術后即刻假體植入再造乳房的探討[J]. 中國實用外科雜志, 2005, 25(2): 8485.
3. Toth BA, Forley BG, Calabria R. Retrospective study of the skinsparing mastectomy in breast reconstruction [J]. Plast Reconstr Surg, 1999, 104(1): 7784.
4. 喬群, 孫家明. 乳房整形美容外科學 [M]. 鄭州: 鄭州大學出版社, 2004: 182186.
5. 左文述. 現(xiàn)代乳腺腫瘤學 [M]. 第2版. 濟南: 山東科學技術出版社, 1996: 12401241.
6. 穆蘭花, 辛敏強, 欒杰, 等. 即刻乳房再造的并發(fā)癥及處理原則 [J]. 中國實用外科雜志, 2008, 28(7): 587588.
7. 劉金香. 早期按摩預防假體隆乳術后包膜囊硬化98例 [J]. 中華醫(yī)學美學美容雜志, 2002, 8(2): 108.
8. 蔣宏傳, 李發(fā)成, 王克有, 等. 乳腺癌改良根治術與乳房即時再造 [J]. 中國微創(chuàng)外科雜志, 2004, 4(5): 390391,394.
9. Fersis N, Hoenig A, Relakis K, et al. Skinsparing mastectomy and immediate breast reconstruction:incidence of recurrence in patients with invasive breast cancer [J]. Breast, 2004, 13(6): 488493.
10. Simmons RM, Fish SK, Gayle L, et al. Local and distant recurrence rates in skinsparing mastectomies compared with nonskinsparing mastectomies [J]. Ann Surg Oncol, 1999, 6(7): 676681.
11. Rivadeneira DE, Simmons RM, Fish SK, et al. Skinsparing mastectomy with immediate breast reconstruction: a critical analysis of local recurrence [J]. Cancer J, 2000, 6(5): 331335.
12. 高海燕, 朱玉蘭, 周曉云. 乳腺癌保留乳頭改良根治術同期假體植入乳房再造術 [J]. 實用臨床醫(yī)藥雜志, 2008, 12(9): 6364.
13. 王穎, 張學慧, 亓發(fā)芝. 保留皮膚的乳腺癌改良根治術后即刻乳房再造的臨床應用 [J/CD]. 中華乳腺病雜志(電子版), 2008, 2(3): 279288.
14. 邵志敏, 余科達. 乳腺外科的發(fā)展趨勢 [J]. 中國普外基礎與臨床雜志, 2007, 14(3): 252254.
15. Chagpar A, Langstein HN, Kronowitz SJ, et al. Treatment and outcome of patients with chest wall recurrence after mastectomy and breast reconstruction [J]. Am J Surg, 2004, 187(2): 164169.
16. Langstein HN, Cheng MH, Singletary SE, et al. Breast cancer recurrence after immediate reconstruction:patterns and significance [J]. Plast Reconstr Surg, 2003, 111(2): 712720.
17. Murphy RX, Wahhab S, Rovito PF, et al. Impact of immediate reconstruction on the local recurrence of breast cancer after mastectomy [J]. Ann Plast Surg, 2003, 50(4): 333338.
18. Garwood ER, Moore D, Ewing C, et al. Total skinsparing mastectomy: complications and local recurrence rates in 2 cohorts of patients [J]. Ann Surg, 2009, 249(1): 2632.
19. 吳祥德, 董守義. 乳腺疾病診治 [M]. 第2版. 北京: 人民衛(wèi)生出版社, 2009: 404411.
20. 蔣宏傳, 苗蕊. 乳腺癌術后乳房重建進展 [J]. 中國普外基礎與臨床雜志, 2010, 17(12): 12211224.
21. Birdsell DC, Jenkins H, Berkel H. Breast cancer diagnosis and survival in women with and without breast implants [J]. Plast Reconstr Surg, 1993, 92(5): 795800.
22. Cronin TD, Gerow FJ. Augmentation mammaplasty: A new “natural feel” prosthesis [C]. Trans Third Int Congr Plastic Surgeons. New York: Excerpta Medica, 1963: 4149.
23. Ahmed S, Snelling A, Bains M, et al. Breast reconstruction [J]. BMJ, 2005, 330(7497): 943948.
24. Cicchetti S, Leone MS, Franchelli S, et al. Onestage breast reconstruction using McGhan Style 150 biodimensional expanders: a review of 107 implants with six years experience [J]. J Plast Reconstr Aesthet Surg, 2006, 59(10): 10371042.
25. 朱毓平. 乳腺癌改良根治術后一期乳房假體再造乳房的討論 [J]. 中國現(xiàn)代醫(yī)學雜志, 2008, 18(22): 33273328, 3331.
  1. 1. 張欣, 張蒲容, 陳潔, 等. 關于女性乳腺疾病患者對保乳及乳房重建認同度的調(diào)查 [J]. 中國普外基礎與臨床雜志, 2010, 17(12): 12401244.
  2. 2. 蔣宏傳, 李發(fā)成, 李杰. 保留皮膚的乳腺癌改良根治術后即刻假體植入再造乳房的探討[J]. 中國實用外科雜志, 2005, 25(2): 8485.
  3. 3. Toth BA, Forley BG, Calabria R. Retrospective study of the skinsparing mastectomy in breast reconstruction [J]. Plast Reconstr Surg, 1999, 104(1): 7784.
  4. 4. 喬群, 孫家明. 乳房整形美容外科學 [M]. 鄭州: 鄭州大學出版社, 2004: 182186.
  5. 5. 左文述. 現(xiàn)代乳腺腫瘤學 [M]. 第2版. 濟南: 山東科學技術出版社, 1996: 12401241.
  6. 6. 穆蘭花, 辛敏強, 欒杰, 等. 即刻乳房再造的并發(fā)癥及處理原則 [J]. 中國實用外科雜志, 2008, 28(7): 587588.
  7. 7. 劉金香. 早期按摩預防假體隆乳術后包膜囊硬化98例 [J]. 中華醫(yī)學美學美容雜志, 2002, 8(2): 108.
  8. 8. 蔣宏傳, 李發(fā)成, 王克有, 等. 乳腺癌改良根治術與乳房即時再造 [J]. 中國微創(chuàng)外科雜志, 2004, 4(5): 390391,394.
  9. 9. Fersis N, Hoenig A, Relakis K, et al. Skinsparing mastectomy and immediate breast reconstruction:incidence of recurrence in patients with invasive breast cancer [J]. Breast, 2004, 13(6): 488493.
  10. 10. Simmons RM, Fish SK, Gayle L, et al. Local and distant recurrence rates in skinsparing mastectomies compared with nonskinsparing mastectomies [J]. Ann Surg Oncol, 1999, 6(7): 676681.
  11. 11. Rivadeneira DE, Simmons RM, Fish SK, et al. Skinsparing mastectomy with immediate breast reconstruction: a critical analysis of local recurrence [J]. Cancer J, 2000, 6(5): 331335.
  12. 12. 高海燕, 朱玉蘭, 周曉云. 乳腺癌保留乳頭改良根治術同期假體植入乳房再造術 [J]. 實用臨床醫(yī)藥雜志, 2008, 12(9): 6364.
  13. 13. 王穎, 張學慧, 亓發(fā)芝. 保留皮膚的乳腺癌改良根治術后即刻乳房再造的臨床應用 [J/CD]. 中華乳腺病雜志(電子版), 2008, 2(3): 279288.
  14. 14. 邵志敏, 余科達. 乳腺外科的發(fā)展趨勢 [J]. 中國普外基礎與臨床雜志, 2007, 14(3): 252254.
  15. 15. Chagpar A, Langstein HN, Kronowitz SJ, et al. Treatment and outcome of patients with chest wall recurrence after mastectomy and breast reconstruction [J]. Am J Surg, 2004, 187(2): 164169.
  16. 16. Langstein HN, Cheng MH, Singletary SE, et al. Breast cancer recurrence after immediate reconstruction:patterns and significance [J]. Plast Reconstr Surg, 2003, 111(2): 712720.
  17. 17. Murphy RX, Wahhab S, Rovito PF, et al. Impact of immediate reconstruction on the local recurrence of breast cancer after mastectomy [J]. Ann Plast Surg, 2003, 50(4): 333338.
  18. 18. Garwood ER, Moore D, Ewing C, et al. Total skinsparing mastectomy: complications and local recurrence rates in 2 cohorts of patients [J]. Ann Surg, 2009, 249(1): 2632.
  19. 19. 吳祥德, 董守義. 乳腺疾病診治 [M]. 第2版. 北京: 人民衛(wèi)生出版社, 2009: 404411.
  20. 20. 蔣宏傳, 苗蕊. 乳腺癌術后乳房重建進展 [J]. 中國普外基礎與臨床雜志, 2010, 17(12): 12211224.
  21. 21. Birdsell DC, Jenkins H, Berkel H. Breast cancer diagnosis and survival in women with and without breast implants [J]. Plast Reconstr Surg, 1993, 92(5): 795800.
  22. 22. Cronin TD, Gerow FJ. Augmentation mammaplasty: A new “natural feel” prosthesis [C]. Trans Third Int Congr Plastic Surgeons. New York: Excerpta Medica, 1963: 4149.
  23. 23. Ahmed S, Snelling A, Bains M, et al. Breast reconstruction [J]. BMJ, 2005, 330(7497): 943948.
  24. 24. Cicchetti S, Leone MS, Franchelli S, et al. Onestage breast reconstruction using McGhan Style 150 biodimensional expanders: a review of 107 implants with six years experience [J]. J Plast Reconstr Aesthet Surg, 2006, 59(10): 10371042.
  25. 25. 朱毓平. 乳腺癌改良根治術后一期乳房假體再造乳房的討論 [J]. 中國現(xiàn)代醫(yī)學雜志, 2008, 18(22): 33273328, 3331.