乳房即刻重建术中胸肌筋膜组织瓣覆盖假体的应用分析
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摘要
目的探讨乳腺癌乳房切除后即刻假体乳房重建术中采用胸肌筋膜覆盖假体的可行性及安全性。方法采用胸肌筋膜覆盖假体的方法行即刻乳房重建术的早期乳腺癌病人27例,对病人术后近期和远期并发症、术后外观满意度、局部复发率、远处转移率及死亡率等进行评估。结果术后随访3～28个月,中位随访13个月。1例病人出现乳头部分缺血坏死,经换药后愈合,其他病人切口均Ⅰ/甲愈合,术后未出现出血、感染等近期并发症。重建乳房无假体外露、假体移位及包膜挛缩等远期并发症,术后外观评价优良率100%(优21例,良6例)。随访期间所有病人无局部复发、远处转移及死亡。结论对早期乳腺癌病人行乳房切除术后采用胸肌筋膜覆盖假体进行即刻乳房重建术,是一种安全、可行的乳房即刻重建方法。
Objective To explore the method of implant coverage with pectoralis major fascia in immediate implant-based breast reconstruction and to evaluate the feasibility and security. Methods 27 patients with early breast cancer underwent immediate implant-based breast reconstruction after mastectomy with the implant covered by a musculofascial layer composed of the pectoralis major muscle and the superficial pectoral fascia. The therapeutic efficiency and safety was evaluated by retrospectively analyzing the clinical data including the short-and long-term complications,cosmetic results,local recurrence,distant metastases and mortality rates. Results Minor and major complications were reported in a period of follow-up ranging from 3 ～ 28 months( median,13 months). One patient had partial nipple necrosis postoperatively and was cured,and no other postoperative complications of hematoma,infection was found. During the follow-up period,no exposure of the implant,implant displacement and capsular contracture were observed. The reconstructive outcomes were excellent in 21 cases and good in 6 case,with an excellent and good rate of 100%. No local recurrence or distant metastasis or death occurred in any of the patients. Conclusion The superficial pectoral fascia flaps can be effectively and safely used as an autologous tissue layer to cover implant in immediate breast reconstruction after mastectomy.
Objective To explore the method of implant coverage with pectoralis major fascia in immediate implant-based breast reconstruction and to evaluate the feasibility and security. Methods 27 patients with early breast cancer underwent immediate implant-based breast reconstruction after mastectomy with the implant covered by a musculofascial layer composed of the pectoralis major muscle and the superficial pectoral fascia. The therapeutic efficiency and safety was evaluated by retrospectively analyzing the clinical data including the short-and long-term complications,cosmetic results,local recurrence,distant metastases and mortality rates. Results Minor and major complications were reported in a period of follow-up ranging from 3 ～ 28 months( median,13 months). One patient had partial nipple necrosis postoperatively and was cured,and no other postoperative complications of hematoma,infection was found. During the follow-up period,no exposure of the implant,implant displacement and capsular contracture were observed. The reconstructive outcomes were excellent in 21 cases and good in 6 case,with an excellent and good rate of 100%. No local recurrence or distant metastasis or death occurred in any of the patients. Conclusion The superficial pectoral fascia flaps can be effectively and safely used as an autologous tissue layer to cover implant in immediate breast reconstruction after mastectomy.
引文
[1]Reshma Jagsi,Jing Jiang,Adeyiza O,et al.Complications after mastectomy and immediate breast reconstruction for breast cancer:a claims-based analysis[J].Ann Surg,2016,263(2):219-227.
[2]Munhoz AM,Aldrighi C,Montag E,et al.Optimizing the nipple-areola sparing mastectomy with double concentric periareolar incision and biodimensional expander-implant reconstruction:aesthetic and technical refinements[J].Breast,2009,18(6):356-367.
[3]吴炅.肿瘤整形技术在乳腺癌治疗中的应用[J].临床外科杂志,2016,24(9):660-662.
[4]Le GM,O'Malley CD,Glaser SL,et al.Breast implants following mastectomy in women with early-stage breast cancer:prevalence and impact on survival[J].Breast Cancer Research,2005,7(2):R184-R193.
[5]李广学,穆籣,刘岩,等.即刻假体乳房再造术中邻近组织覆盖假体的初步研究[J].中国修复重建外科杂志,2016,30(3):385-388.
[6]Bordoni D,Cadenelli P,Rocco N,et al.Serratus anterior fascia flap versus muscular flap for expander coverage in two-stage breast reconstruction following mastectomy:early post-operative outcomes[J].Aesth Plast Surg,2017,41(1):26-30.
[7]Graf RM,Bernardes A,Rippel R,et al.Subfascial breast implant:a new procedure[J].Plast Reconstr Surg,2003,111(2):904-908.
[8]Lee JH,Lee PK,Oh DY,et al.Subpectoral-subfascial breast augmentation for thin-skinned patients[J].Aesth Plast Surg,2012,36(1):115-121.
[9]Tijerina VN,Saenz RA,Garcia-Guerrero J.Experience of 1000 cases on subfascial breast augmentation[J].Aesth Plast Surg,2010,34(1):16-22.
[10]Jinde L,Xiaoping C,Wanquan Z,et al.Can the pectoral fascia integrity be preserved during subfascial breast augmentation through the axillary approach[J]?Aesthetic Plast Surg,2010,34(1):29-32.
[11]Morales-Avalos R,Soto-Domínguez A,García-Juárez J,et al.Morphological and histomorphometric evaluation of the ventral rectus sheath of the rectus abdominis muscle,fascia lata and pectoral fascia.The beginning of a morphological information bank of human fascias[J].Histol Histopathol,2017,32(3):271-282.
[12]Lin Jinde,Song Jianliang,Chen Xiaoping,et al.Anatomy and clinical significance of pectoral fascia[J].Plast Reconstr Surg,2006,118(7):1557-1560.
[13]Dalberg K,Krawiec K,Sandelin K.Eleven-year follow-up of a randomized study of pectoral fascia preservation after mastectomy for early breast cancer[J].World J Surg,2010,34(11):2539-2544.
[14]邹伟伟,白玉,王希龙,等.胸大肌筋膜在乳腺癌乳房切除后即刻乳房重建中的应用[J].中国普通外科杂志,2017,26(11):1447-1452.
[15]厉红元.乳腺癌术后乳房重建技术[J].外科理论与实践,2014,19(5):377-379.
[2]Munhoz AM,Aldrighi C,Montag E,et al.Optimizing the nipple-areola sparing mastectomy with double concentric periareolar incision and biodimensional expander-implant reconstruction:aesthetic and technical refinements[J].Breast,2009,18(6):356-367.
[3]吴炅.肿瘤整形技术在乳腺癌治疗中的应用[J].临床外科杂志,2016,24(9):660-662.
[4]Le GM,O'Malley CD,Glaser SL,et al.Breast implants following mastectomy in women with early-stage breast cancer:prevalence and impact on survival[J].Breast Cancer Research,2005,7(2):R184-R193.
[5]李广学,穆籣,刘岩,等.即刻假体乳房再造术中邻近组织覆盖假体的初步研究[J].中国修复重建外科杂志,2016,30(3):385-388.
[6]Bordoni D,Cadenelli P,Rocco N,et al.Serratus anterior fascia flap versus muscular flap for expander coverage in two-stage breast reconstruction following mastectomy:early post-operative outcomes[J].Aesth Plast Surg,2017,41(1):26-30.
[7]Graf RM,Bernardes A,Rippel R,et al.Subfascial breast implant:a new procedure[J].Plast Reconstr Surg,2003,111(2):904-908.
[8]Lee JH,Lee PK,Oh DY,et al.Subpectoral-subfascial breast augmentation for thin-skinned patients[J].Aesth Plast Surg,2012,36(1):115-121.
[9]Tijerina VN,Saenz RA,Garcia-Guerrero J.Experience of 1000 cases on subfascial breast augmentation[J].Aesth Plast Surg,2010,34(1):16-22.
[10]Jinde L,Xiaoping C,Wanquan Z,et al.Can the pectoral fascia integrity be preserved during subfascial breast augmentation through the axillary approach[J]?Aesthetic Plast Surg,2010,34(1):29-32.
[11]Morales-Avalos R,Soto-Domínguez A,García-Juárez J,et al.Morphological and histomorphometric evaluation of the ventral rectus sheath of the rectus abdominis muscle,fascia lata and pectoral fascia.The beginning of a morphological information bank of human fascias[J].Histol Histopathol,2017,32(3):271-282.
[12]Lin Jinde,Song Jianliang,Chen Xiaoping,et al.Anatomy and clinical significance of pectoral fascia[J].Plast Reconstr Surg,2006,118(7):1557-1560.
[13]Dalberg K,Krawiec K,Sandelin K.Eleven-year follow-up of a randomized study of pectoral fascia preservation after mastectomy for early breast cancer[J].World J Surg,2010,34(11):2539-2544.
[14]邹伟伟,白玉,王希龙,等.胸大肌筋膜在乳腺癌乳房切除后即刻乳房重建中的应用[J].中国普通外科杂志,2017,26(11):1447-1452.
[15]厉红元.乳腺癌术后乳房重建技术[J].外科理论与实践,2014,19(5):377-379.