CAJ | 학술논문

目的探讨乳腺癌保留皮肤全乳切除(SSM)联合一期乳房重建(IBR)的安全性、适应证、美容效果及其对辅助治疗的影响.方法对1999年10月至2007年5月共129例接受SSM+IBR手术的乳腺癌患者进行回顾性分析.采用背阔肌或背阔肌联合假体、带蒂横行腹直肌肌皮瓣等方法行乳房重建.结果平均住院18.6 d,术后首次化疗开始时间平均为术后第5.2天.假体包囊挛缩11例(11/63,17.5%),背部供区血清肿24例(24/99,24.2%),腹直肌肌皮瓣或腹壁下动脉穿支皮瓣部分坏死或硬结9例(9/28,32.1%).未接受放疗患者对重建乳房外观的可接受度为89.7%,高于接受放疗患者的68.2%(P<0.01).随访2-73个月,中位随访11个月.局部复发5例,远处转移7例.结论 SSM+IBR对于0～Ⅱa期乳腺癌患者是安全的,能同时满足肿瘤治疗及形体美容的要求.放疗对于重建乳房的外观有一定的负面影响,对于需要术后放疗的患者,可以考虑延期或者延期-即时乳房重建.
목적 탐토유선암보류피부전유절제(SSM)연합일기유방중건(IBR)적안전성、괄응증、미용효과급기대보조치료적영향.방법 대1999년10월지2007년5월공129례접수SSM+IBR수술적유선암환자진행회고성분석.채용배활기혹배활기연합가체、대체횡행복직기기피판등방법행유방중건.결과 평균주원18.6 d,술후수차화료개시시간평균위술후제5.2천.가체포낭련축11례(11/63,17.5%),배부공구혈청종24례(24/99,24.2%),복직기기피판혹복벽하동맥천지피판부분배사혹경결9례(9/28,32.1%).미접수방료환자대중건유방외관적가접수도위89.7%,고우접수방료환자적68.2%(P<0.01).수방2-73개월,중위수방11개월.국부복발5례,원처전이7례.결론 SSM+IBR대우0～Ⅱa기유선암환자시안전적,능동시만족종류치료급형체미용적요구.방료대우중건유방적외관유일정적부면영향,대우수요술후방료적환자,가이고필연기혹자연기-즉시유방중건.
Objective To evaluate the oncologic safety,indications and aesthetic results for skin-sparing mastectomy(SSM) and immediate breast reconstruction(IBR).Method One hundred and twenty-nine breast cancer patients treated by SSM+IBR from October 1999 to May 2007 were reviewed.Reconstructive techniques included tatissimus dorsi flaps(38 patients),implants only(2 patients),latissimus dorsi flaps plus implants(61 patients),pedicled transverse rectus abdominis myocutaneous (TRAM)flaps(25 patients)and deep inferior epigastric artery perforator(DIEP)flaps(3 patients).Aesthetic results were iudged by patients' self-evaluation.Results Mcan duration of hospitalization was 18.6 days.Time of first chemotherapy was 5.2 days after operation.Eleven patients(11/63,17.5%)developed capsular contracture and 24 patients(24/99,24.2%)developed seroma in the donor site.Nine patients(9/28,32.1%)developed partial fat necrosis in TRAM and DIEP flaps.The satisfaction with the aesthetic results of the reconstructive breast Was significantly lower in irradiated patients than non-irradiated ones.Median follow-up time Was 11 months.Five patients developed local recurrence and 7 patients with metastasis.Conclusions SSM with IBR can be used for the 0 to Ⅱ a stage breast cancer patients,with surgical oncologic and aesthetic satisfaction.Radiotherapy has an adverse effect on the reconstructive breast.Delayed or delayed-immediate reconstructions are recommended for patients indicated to postoperative radiotherapy.