CAJ | 학술논문

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.
배경:근년래유선종괴적검출솔교이전명현증가,채용하충술식불부관계도환자술후시부복발,환관계도저문술후자신심중건적문제.소이,최대한도적감소환자생리화심리상적창상응해성위외과의생선택술식적수요인소.목적:관찰보류유방피부적유선절제후응용복직기기피판、배활기기피판가유방가체、국부피판여단순유방가체4충방식즉각재조유방적효과.설계:병례분석.단위:기남대학의학원제이림상의학원,심수시인민의원정형외과.대상:15례환유선도관내원위암화거대유선량성종류환자위심수시인민의원1997-10/2004-05수치,년령20～46세,균위단측유방환병.기중8례위유선도관내원위암,T1N0M0,7례위거대유선량성종류.소유수술술전균향환자고지수술방안,정득환자동의.방법:채용보류유방피부적유훈배형절구행유선혹거대종류적유방피하절제술,응용복직기기피판、배활기기피판가유방가체、국부피판여단순유방가체4충불동술식행즉각재조유방,충전유방적내용,기피판재조시부이소량적기피판피부미보절제후적유두유훈부위.재차수술시재해전이적피판상재조유두.주요관찰지표:관찰술후환자유무복발혹전이,상구국부유합정황.결과:경다전과협작완성15례수술,14례수방시간1년이상,무종류복발.재조유방여건측유방대칭,보류료원유유방피부적감각,외관형태자연,반흔교소차은폐.결론:재엄격수술괄응증방지유선암복발적전제하,차법위일교완선적유선절제여유방재조방법.
BACKGROUND: Recently the prevalence rate of mass in mammary gland increases significantly than before. To use which kind of technology is not only related with the post-operation recurrence, but also related with the reconstruction of their confidence. Therefore, how to reduce the trauma physically and psychologically in patients to the maximal degree has become the chief factor to choose technology by surgeons.OBJECTIVE: To observe the effects of transverse rectus abdominis musculocutaneous (TRAM) flap, latissimus dorsi musculocutaneous flap with breast prothesis, local flap and simple breast prothesis after skin-sparing mastectomy with immediate breast reconstruction.DESIGN: Case analysis.SETTING: Department of Plastic Surgery, Shenzhen People's Hospital,Second Clinical Medical College of Jinan University.PARTICIPANTS: A total of 15 ductal carcinoma in situ (DCIS) and huge breast benign tumor patients were enrolled into Shenzhen People's Hospital between October 1997 and May 2004, aged from 20 to 46 years. They all got disease in single breast, and 8 of them had preoperative diagnosis of DCIS, T1N0M0 and 7 of them had huge breast benign tumor. Operation program was informed to the patients before operation so as to gain their agreement.METHODS: Skin-sparing mastectomy was performed with circular shape incision at areola and using TRAM flap, latissimus dorsi musculocutaneous flap with breast prothesis, local flap and simple breast prothesis to fill breast. Slight skin of musculo-cutaneous flap could compensate the nipple and areola when performing reconstruction. At the reoperation, nipple was made at the transferred flap.MAIN OUTCOME MEASURES: To observe the patients with or without recurrence or transfer after operation and local healing of wound.RESULTS: With the cooperation of general surgeons the operation was done in 15 cases and 14 cases of them were followed up for more than 1 year. The reconstructed breasts were with good symmetry with the opposite one, normal skin sensation, natural shape and inconspicuous scar.CONCLUSION: This is an excellent alternative method for mastectomy and breast reconstruction based on the avoidance of recurrence of breast cancer in severe operation.