论文部分内容阅读
摘 要 目的：探讨乳腺癌保乳手术中整形性体积易位技术对乳房美容效果的影响。方法：43例经穿刺活检确诊的Ⅰ、Ⅱ期乳腺癌，均行肿瘤扩大切除术及腋淋巴结清扫术。其中，直接缝合组22例，术中对乳腺体缺损不予缝合，直接缝合皮肤关闭创腔；乳腺体重建组21例，术中采用肿瘤整形性体积易位技术，游离剩余乳腺组织瓣，转移修复乳腺体缺损，再缝合皮肤。术后均给予全乳三维适行放射治疗、规范化疗和内分泌治疗。术后3年自拟标准回顾性历史对照分析两组患者乳房美容效果。结果：直接缝合组美容评分4.3分，优良率40.9%(9/22)；乳腺体重建组美容评分4.8分，优良率71.4%(15/21)，P＜0.01，乳腺体重建组乳房美容效果优于直接缝合组。结论：乳腺癌保乳术中采用体积易位技术对乳腺体塑形缝合，术后乳房美容效果更好。
关键词 乳腺癌 保乳手术 体积易位技术 美容效果
doi:10.3969/j.issn.1007-614x.2012.02.178
Abstract Objective:To explore breast cosmetic results utilizing different repair methods in Zonal excision of breast for stage Ⅰand Ⅱ breast cancer patients.Methods:43 cases of Breast cancer patients in stageⅠand Ⅱ with pathological diagnosis by core needle biopsy were operated by Zonal excision of breast combined with axillary lymph nodes dissection.Among the total,Wound cavity of 22 cases was repaired by direct skin suture,and of other 21 cases was repaired by breast tissue valve translocation.All of them were treated with three-dimension conformal radiotherapy,standard chemotherapy and endocrine therapy after operation.3 years after partial removal of breast,A retrospective historical controls study has been fulfilled to analyze breast cosmetic results between two groups.Results:In direct suture group,the cosmetology score is 4.3 points and good rate is 40.9%(9/22).In breast cosmetic reconstruction group,the score is 4.8 points and good rate is 71.4%(15/21).The breast cosmetic in breast cosmetic reconstruction group is better than in direct suture group significantly(P＜0.01).Conclusion:It will get better breast cosmetic results among breast cancer patitens after operation to utilize breast body moulding sature according to the requirement of breast cosmetic surgery in Breast-conserving surgery.
Key Words Breast cancer;Breast-conserving surgery;Volume displacement techniques;Cosmetic results
2001年3月～2005年6月行保乳术乳腺癌患者43例，对手术及术后随访资料进行分析，现将结果报告如下。
资料与方法
本组女性患者43例，均经穿刺活检确诊为乳腺癌，TNM分期Ⅰ～Ⅱ期，术前乳房丰满，无保乳术禁忌证，均要求行保乳手术。
方法：①肿瘤切除方法：采用梭形切口，行距肿块周边2cm之肿块扩大切除加腋窝淋巴结清扫术。术中作冰冻病理检查确保切缘阴性，除肿瘤位于外上象限靠近腋窝的患者外，腋窝清扫均另作切口进行。②乳房缝合方法：直接缝合组：创面止血后，乳腺体缺损不予缝合，直接用微乔线行皮下及皮肤连续皮内缝合。腺体重建组：创面止血后于皮下游离创腔两侧乳腺组织瓣，提起乳头，使两侧游离之乳腺组织瓣靠拢，对位缝合修复乳腺体缺损，再缝合皮肤。切除量近1/4，腺体缺损较多，将较多较厚一侧腺体瓣游离为带蒂腺体瓣，转移至切口下重塑乳丘，多孔引流管接负压引流。③术后辅助治疗：43例患者术后均给予全乳三维适行放射治疗、规范地化疗和内分泌治疗。
评价方案：具体标准，见表1。
结 果
两组患者腺体组织切除量比较，见表2。
讨 论
目前，肿瘤切缘尚无统一标准，要求切缘距肿瘤边缘超过1cm、2cm、3cm均可见文献报道[1]。本文43例局部扩大切除术中，切缘距肿瘤边缘均为2cm，术中快速切片检查均为阴性，术后随访3～5年未见局部复发；直接缝合组美容评分4.3分，优良率40.9%；乳腺体重建组美容评分4.8分，优良率71.4%，P＜0.01。
综上所述，对Ⅰ、Ⅱ期乳腺癌进行保乳手术时，切除足够的组织可以保证切缘阴性，同时采用肿瘤整形性体积易位技术即刻修复乳腺体局部缺损，能够兼顾疗效和美容效果。手术操作简单，并发症少，值得临床推广应用。
参考文献
1 肖春花,张学慧,曹旭晨,等.乳腺癌乳房部分切除术后即刻背阔肌肌皮瓣重建乳房的临床应用［J］.中华医学美学美容杂志,2009,15(3):145-148.
关键词 乳腺癌 保乳手术 体积易位技术 美容效果
doi:10.3969/j.issn.1007-614x.2012.02.178
Abstract Objective:To explore breast cosmetic results utilizing different repair methods in Zonal excision of breast for stage Ⅰand Ⅱ breast cancer patients.Methods:43 cases of Breast cancer patients in stageⅠand Ⅱ with pathological diagnosis by core needle biopsy were operated by Zonal excision of breast combined with axillary lymph nodes dissection.Among the total,Wound cavity of 22 cases was repaired by direct skin suture,and of other 21 cases was repaired by breast tissue valve translocation.All of them were treated with three-dimension conformal radiotherapy,standard chemotherapy and endocrine therapy after operation.3 years after partial removal of breast,A retrospective historical controls study has been fulfilled to analyze breast cosmetic results between two groups.Results:In direct suture group,the cosmetology score is 4.3 points and good rate is 40.9%(9/22).In breast cosmetic reconstruction group,the score is 4.8 points and good rate is 71.4%(15/21).The breast cosmetic in breast cosmetic reconstruction group is better than in direct suture group significantly(P＜0.01).Conclusion:It will get better breast cosmetic results among breast cancer patitens after operation to utilize breast body moulding sature according to the requirement of breast cosmetic surgery in Breast-conserving surgery.
Key Words Breast cancer;Breast-conserving surgery;Volume displacement techniques;Cosmetic results
2001年3月～2005年6月行保乳术乳腺癌患者43例，对手术及术后随访资料进行分析，现将结果报告如下。
资料与方法
本组女性患者43例，均经穿刺活检确诊为乳腺癌，TNM分期Ⅰ～Ⅱ期，术前乳房丰满，无保乳术禁忌证，均要求行保乳手术。
方法：①肿瘤切除方法：采用梭形切口，行距肿块周边2cm之肿块扩大切除加腋窝淋巴结清扫术。术中作冰冻病理检查确保切缘阴性，除肿瘤位于外上象限靠近腋窝的患者外，腋窝清扫均另作切口进行。②乳房缝合方法：直接缝合组：创面止血后，乳腺体缺损不予缝合，直接用微乔线行皮下及皮肤连续皮内缝合。腺体重建组：创面止血后于皮下游离创腔两侧乳腺组织瓣，提起乳头，使两侧游离之乳腺组织瓣靠拢，对位缝合修复乳腺体缺损，再缝合皮肤。切除量近1/4，腺体缺损较多，将较多较厚一侧腺体瓣游离为带蒂腺体瓣，转移至切口下重塑乳丘，多孔引流管接负压引流。③术后辅助治疗：43例患者术后均给予全乳三维适行放射治疗、规范地化疗和内分泌治疗。
评价方案：具体标准，见表1。
结 果
两组患者腺体组织切除量比较，见表2。
讨 论
目前，肿瘤切缘尚无统一标准，要求切缘距肿瘤边缘超过1cm、2cm、3cm均可见文献报道[1]。本文43例局部扩大切除术中，切缘距肿瘤边缘均为2cm，术中快速切片检查均为阴性，术后随访3～5年未见局部复发；直接缝合组美容评分4.3分，优良率40.9%；乳腺体重建组美容评分4.8分，优良率71.4%，P＜0.01。
综上所述，对Ⅰ、Ⅱ期乳腺癌进行保乳手术时，切除足够的组织可以保证切缘阴性，同时采用肿瘤整形性体积易位技术即刻修复乳腺体局部缺损，能够兼顾疗效和美容效果。手术操作简单，并发症少，值得临床推广应用。
参考文献
1 肖春花,张学慧,曹旭晨,等.乳腺癌乳房部分切除术后即刻背阔肌肌皮瓣重建乳房的临床应用［J］.中华医学美学美容杂志,2009,15(3):145-148.