CAJ | 학술논문

目的探讨采用背阔肌皮瓣修复乳腺癌部分乳房切除术后较大范围缺损的治疗和美容效果.方法 24例乳腺癌患者的肿瘤最大径为3.0～5.5 cr,平均3.5 cm.均行保留乳房的病灶广泛切除,所有患者均在术中冰冻切片确定切缘达阴性后,即刻采用背阔肌皮瓣修复局部缺损,术后给予全乳放射治疗±辅助化疗±内分泌治疗.结果全组24例患者背阔肌皮瓣全部成活,背部及乳房皮肤无坏死.术后中位随访23个月,患者均无病生存.全乳放射治疗对转移的背阔肌皮瓣末见明显影响,乳房外观优良率为79.2%,患者主观评价满意度为96.0%.结论采用转移的背阔肌皮瓣修复部分乳房切除术后的较大缺损可获得满意的治疗效果和美容效果,对存在导管内癌、新辅助化疗后、乳房中央区(乳头乳晕区)及较大肿瘤(＞3 cm)等保乳手术相对或绝对禁忌的患者可行保乳手术,扩大了保乳手术的适应证.
목적 탐토채용배활기피판수복유선암부분유방절제술후교대범위결손적치료화미용효과.방법 24례유선암환자적종류최대경위3.0～5.5 cr,평균3.5 cm.균행보류유방적병조엄범절제,소유환자균재술중빙동절편학정절연체음성후,즉각채용배활기피판수복국부결손,술후급여전유방사치료±보조화료±내분비치료.결과 전조24례환자배활기피판전부성활,배부급유방피부무배사.술후중위수방23개월,환자균무병생존.전유방사치료대전이적배활기피판말견명현영향,유방외관우량솔위79.2%,환자주관평개만의도위96.0%.결론 채용전이적배활기피판수복부분유방절제술후적교대결손가획득만의적치료효과화미용효과,대존재도관내암、신보조화료후、유방중앙구(유두유훈구)급교대종류(＞3 cm)등보유수술상대혹절대금기적환자가행보유수술,확대료보유수술적괄응증.
Objective Breast conserving surgery (BCS) is one of standard treatment approaches in early breast cancer.Although most defect after BCS can be repaired, the cosmetic outcomes are unsatisfactory in the patients with poor tumor/breast ratio.Oncoplastic surgery (OPS) has emerged as a new approach for providing adequate tumor resection without compromise of aesthetic outcomes in BCS.Our purpose is to explore the cosmetic outcomes of applying latissimus dorsi (LD) muscle flap to reshape severe breast conservation deformities in breast cancer.Methods Totally 24 cases of breast cancer were studied.The tumor size was 3.0-5.5 cm ( median 3.5 cm).All the cases underwent BCS and achieved negative margin by frozen sections examination.Then LD flap reshaping were performed.All the patients received whole breast radiotherapy ± chemotherapy ± endocrine therapy.Results All the LD flaps were alive without skin necrosis.After a median 23-month follow-up, all the cases were disease-free surviving.The whole breast radiotherapy had no significant effect on the LD flaps.The rate of good cosmetic results was 79.2%.The subjective satisfactory rate of the patients was 96%.Conclusions Both satisfactory aesthetic outcome and good treatment effect were obtained using LD flap to reshape severe breast conservation deformity.OPS offers tools for breast conservation in patients otherwise destined for mastectomy or poor aesthetic outcome, such as large tumor/breast ratio, nipple-areola complex tumor, ductal carcinoma in situ,neoadjuvant chemotherapy cases and so on.