CAJ | 학술논문

目的：探讨利用标本中皮肤移植预防较大肿块乳腺癌手术后皮瓣坏死的疗效。方法105例行乳腺癌改良根治术患者随机分为观察组（53例）和对照组（52例），两组平均病灶直径分别为5．3 cm和5．5 cm。观察组在切除标本后，最大限度地切取距病灶3 cm以远对侧的皮肤制成中厚皮瓣，经冰冻病理检查确诊皮瓣各缘无癌残留后，将此皮瓣移植于切口中央，对照组则经充分游离或整形后缝合。结果观察组术后皮瓣坏死5例（9．4％），其中轻度4例，中度1例，住院时间（8．8±1．3）d，手术时间（91±3） min，植皮成活率100％。对照组皮瓣坏死34例（65．4％），其中轻度6例，中度18例，重度10例，二次植皮10例，住院时间（16．1±2．3）d，手术时间（87±3） min。两组皮瓣坏死例数、二次植皮例数、住院时间差异有统计学意义（P＜0．01）；手术时间差异无统计学意义（P＞0．05）。随访4～7年，观察组植皮区无复发或转移。结论在确保植皮皮肤切缘无癌残留的情况下，利用标本中皮肤移植预防较大肿块乳腺癌术后皮瓣坏死是一种安全有效的方法，值得临床应用。
목적：탐토이용표본중피부이식예방교대종괴유선암수술후피판배사적료효。방법105례행유선암개량근치술환자수궤분위관찰조（53례）화대조조（52례），량조평균병조직경분별위5．3 cm화5．5 cm。관찰조재절제표본후，최대한도지절취거병조3 cm이원대측적피부제성중후피판，경빙동병리검사학진피판각연무암잔류후，장차피판이식우절구중앙，대조조칙경충분유리혹정형후봉합。결과관찰조술후피판배사5례（9．4％），기중경도4례，중도1례，주원시간（8．8±1．3）d，수술시간（91±3） min，식피성활솔100％。대조조피판배사34례（65．4％），기중경도6례，중도18례，중도10례，이차식피10례，주원시간（16．1±2．3）d，수술시간（87±3） min。량조피판배사례수、이차식피례수、주원시간차이유통계학의의（P＜0．01）；수술시간차이무통계학의의（P＞0．05）。수방4～7년，관찰조식피구무복발혹전이。결론재학보식피피부절연무암잔류적정황하，이용표본중피부이식예방교대종괴유선암술후피판배사시일충안전유효적방법，치득림상응용。
Objective To investigate the effect of specimen skin transplantation in prevention of skin flap necrosis after large lump breast carcinoma surgery .Methods A hundred and five cases who underwent modified radical mastectomy were randomly assigned into observation group (n=53) and control group (n=52).The average diameter of the lesion lump of observation group and control group were 5.3cm and 5.5cm respectively.In observation group,contralateral skin which was at least 3cm away from the lesion was cut and was made to split thick skin graft after the carcinoma was excised .The flap was confirmed that there was no residual carcinoma in the margin by the frozen biopsy ,and then was transplanted to the center of cutting .In the control group ,skin was sutured after freed or skin plasty.Results The rate of skin flap necrosis in the observation group was 5 cases (9.4%),of which mild,moderate necrosis were 4 cases,1 case respectively.The hospital stays were(8.8 ±1.3) days and the operation time was(91 ±3) minutes.The survival rate of skin flap was 100%.The rate of skin flap necrosis in control group was 34 cases(65.4%),of which mild,moderate,severe necrosis were 6 cases,18 cases and 10 cases respectively .Ten cases underwent skin transplantation again .The hospital stays were (16.1 ±2.3) days and the operation time was (87 ±3) minutes.The cases of skin flap necrosis ,undergoing skin transplantation again and the hospital stays were significantly different between the two groups (P<0.01).The operation time was not significantly different between the two groups (P>0.05).No recurrence and metastasis were found by 4~7 years of follow-up in the observation group.Conclusions When no residual cancer confirmed ,the method of adopting specimens skin transplantation to prevent skin flap necrosis after large lump breast carcinoma surgery is safe and effective ,which is worthy of clinical application .