CAJ | 학술논문

目的探讨剖宫产后瘢痕者行横行腹直肌(transverse rectus abdominis myocutaneous,TRAM)肌皮瓣乳房再造的可行性和手术策略.方法对12例有剖宫产史的乳腺癌患者实施TRAM肌皮瓣乳房再造术.所有患者的TRAM肌皮瓣应用危险因素评分均为0.5分,Ⅱ类.采用腹部倒梯形手术切口,切口上缘下距脐2～3 cm,对1例腹部纵切口瘢痕较长者采用腹直肌双蒂,其余均为患乳对侧腹直肌单蒂,并携带同侧腹直肌前鞘,对腹直肌和前鞘缺损以聚丙烯网片修补.结果全部12例皮瓣成活,无腹部并发症发生,随访3～52个月,满意率达100％.结论带剖宫产瘢痕者行TRAM肌皮瓣乳房再造需严格选择病例,并要求制定相应的手术策略.
목적 탐토부궁산후반흔자행횡행복직기(transverse rectus abdominis myocutaneous,TRAM)기피판유방재조적가행성화수술책략.방법 대12례유부궁산사적유선암환자실시TRAM기피판유방재조술.소유환자적TRAM기피판응용위험인소평분균위0.5분,Ⅱ류.채용복부도제형수술절구,절구상연하거제2～3 cm,대1례복부종절구반흔교장자채용복직기쌍체,기여균위환유대측복직기단체,병휴대동측복직기전초,대복직기화전초결손이취병희망편수보.결과 전부12례피판성활,무복부병발증발생,수방3～52개월,만의솔체100％.결론 대부궁산반흔자행TRAM기피판유방재조수엄격선택병례,병요구제정상응적수술책략.
Objective To investigate the availability and strategy of breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.Methods From January 2007 to May 2011,12 cases of breast reconstruction with caesarotomy scar were carried out with pedicled TRAM flaps.All the patients that were classified as the class Ⅱ that was 0.5 or less by score were operated on by using the inverted trapezoid incision,of which the upper edge was 2 or 3 cm down to the umbilicus.Double pedicles were adopted for the patient with the longest vertical scar; single pedicle of the breast contralateral side and the muscle sheath of the breast ipsilateral side were harvested for the rest of the patients.A synthetic mesh was used for the enforcement of the muscle and sheath defect.Results No flap necrosis or abdominal complications were observed.With the follow-up from 3 months to 4 years and 4 months,the overall satisfactory rate was 100 ％.Conclusions The strict patient selection and the operating strategy are the keys to the successful breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.