CAJ | 학술논문

目的探讨Ⅱ期和Ⅲ期乳腺痛新辅助化疗后行乳房部分切除术,并转移同侧背阔肌肌皮瓣(latissimus dorsal myocutaneous flap, LDM皮瓣)进行即刻重建乳房的临床应用及效果.方法 18例经粗针抽吸病理组织证实的Ⅱ期和Ⅲ期乳腺癌,经新辅助化疗后进行乳房部分切除术,并转移同侧LDM皮瓣进行重建乳房.术后1个月及放疗完成后1个月对重建乳房外形评分,取平均值为最后分值.采用Kaplan-Meier方法进行生存分析.结果肿瘤经新辅助化疗最大直径由30～55 mm缩小至25～45 mm.乳房切除标本平均重量为140 g(90～220 g).重建乳房93.33%(16/18)评分3分以上.5例背部供区皮下积液(27.78%),2例背部切口裂开(11.11%).平均随访22个月无局部复发,1例(5.55%)远位转移(骨转移),Kaplan-Meier生存曲线与同期根治术比较无差异.结论联合新辅助化疗的Ⅱ期和Ⅲ期乳腺癌部分乳房切除术后转移LDM皮瓣重建乳房,可提高乳房外形的满意度.
목적 탐토Ⅱ기화Ⅲ기유선통신보조화료후행유방부분절제술,병전이동측배활기기피판(latissimus dorsal myocutaneous flap, LDM피판)진행즉각중건유방적림상응용급효과.방법 18례경조침추흡병리조직증실적Ⅱ기화Ⅲ기유선암,경신보조화료후진행유방부분절제술,병전이동측LDM피판진행중건유방.술후1개월급방료완성후1개월대중건유방외형평분,취평균치위최후분치.채용Kaplan-Meier방법진행생존분석.결과 종류경신보조화료최대직경유30～55 mm축소지25～45 mm.유방절제표본평균중량위140 g(90～220 g).중건유방93.33%(16/18)평분3분이상.5례배부공구피하적액(27.78%),2례배부절구렬개(11.11%).평균수방22개월무국부복발,1례(5.55%)원위전이(골전이),Kaplan-Meier생존곡선여동기근치술비교무차이.결론 연합신보조화료적Ⅱ기화Ⅲ기유선암부분유방절제술후전이LDM피판중건유방,가제고유방외형적만의도.
Objective To study the immediate conservative breast surgical reconstruction by trans-ferring the same lateral latissimus dorsal myocutaneous flap (LDM) for the treatment of stage Ⅱ and stage Ⅲ breast cancer, combined with neoadjuvant chemotherapy. Methods Breast cancer patients in stage Ⅱ and Ⅲ with pathological diagnosis by core needle biopsy, had undergone immediate conservative breast reconstruction surgery with transferring the latissimus dorsal myocutaneous (LDM). We scored the reconstructed breast twice at one month after operation and completion of radiation. The final score was decided using the mean value of the twice evaluating score. Kaplan-Meier survival was used to analyze the survival of 18 cases with traditional mastectomy. Results The tumor size ranged from 30 mm to 55 mm before neoadjuvant chemotherapy, and ranged from 25mm to 45 mm after neoadjuvant chemotherapy. The median weight of the tumor specimens in breast conservative operation was 140 g (90 g to 220 g). A-mong the 18 patients, 16 cases had more than 3 scores with satisfied cosmetics (93.33 % ). Dorsal subcu-taneous seroma in donation area was observed in 5 of 18 patients (27.78 %) and dorsal incision dehiscence was observed in 2 of 18 patients (11.11%). None of the patients developed recurrence except that 1 pa-tient (5.55 %) had distance metastasis (bone metastasis} in a mean 22-months follow-up. The Kaplan-Meier survival curve in breast conservation reconstruction patients had no different from that of traditional mastectomy patients at the same time. Conclusions Immediate conservative breast surgical reconstruction by using the same lateral latissimus dorsal myocutaneous flap is an effective method for stage Ⅱ and stage Ⅲ breast cancer patients combined with neoadjuvant chemotherapy, which can increase satisfactory breast so that cosmetic outcome can be reached.