Ross A C, Rusnak C H, Hill M K, Naysmith J D, Taylor S L, Dunlop W E, Hayashi A H
Department of General Surgery, McGill University, Montreal, Quebec, Canada.
Am J Surg. 2000 May;179(5):412-6. doi: 10.1016/s0002-9610(00)00357-3.
Breast reconstruction is currently offered on a more routine basis to patients after mastectomy for breast cancer. This paper analyzes the outcomes of breast cancer surgery, and the results and effects of breast reconstruction using free TRAM flaps.
A retrospective review of 75 consecutive patients who had free transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction after breast cancer surgery was performed. A total of 92 free TRAM flaps were performed on 75 patients in Victoria, British Columbia, from January 1992 to May 1999. Thirty-three patients (44%) underwent primary breast cancer surgery and an immediate reconstruction (7 bilateral and 27 unilateral) and 42 patients (56%) had delayed reconstruction (10 bilateral and 32 unilateral).
Twenty- one patients (28%) had stage 0 disease, 20 (26.7%) had stage I disease, 17 (22.7%) had stage IIA disease, 12 (15%) had stage IIB disease, and 4 (5.3%) had stage IIIA disease. In 1 patient the stage of disease was unknown. The mean patient age was 49.4 years (range 33 to 73). Of the patients undergoing immediate reconstruction 3 had postoperative chemotherapy and 1 had postoperative radiotherapy. Three patients had combined chemoradiotherapy. In none of these cases was the adjuvant therapy delayed by the reconstructive surgery. Overall mean follow-up time from cancer diagnosis was 56.8 months and from the time of TRAM flap reconstruction, 36.7 months. To date, 5 recurrences have been detected (6.6%). Mean time between reconstruction and detection of recurrence was 22.8 months. Detection of recurrence was achieved clinically and was not impaired in any of the cases by the presence of the free flap. Patient satisfaction was assessed via a telephone survey, with 93% of patients pleased with the cosmetic results of their surgery.
For those patients with breast cancer requiring mastectomy, free TRAM flap reconstruction is a safe, cosmetically acceptable surgical alternative that impairs neither effective breast cancer surgery nor detection of recurrent disease.
目前，乳腺癌乳房切除术后的患者更常规地接受乳房重建手术。本文分析了乳腺癌手术的结果以及使用游离腹直肌肌皮瓣进行乳房重建的效果。
对75例乳腺癌手术后接受游离横腹直肌肌皮瓣（TRAM）乳房重建的连续患者进行回顾性研究。1992年1月至1999年5月，在不列颠哥伦比亚省维多利亚市的75例患者中共进行了92例游离TRAM瓣手术。33例患者（44%）接受了原发性乳腺癌手术并立即进行了重建（7例双侧和27例单侧），42例患者（56%）进行了延迟重建（10例双侧和32例单侧）。
21例患者（28%）为0期疾病，20例（26.7%）为I期疾病，17例（22.7%）为IIA期疾病，12例（15%）为IIB期疾病，4例（5.3%）为IIIA期疾病。1例患者的疾病分期未知。患者平均年龄为49.4岁（范围33至73岁）。在接受立即重建的患者中，3例接受了术后化疗，1例接受了术后放疗。3例患者接受了放化疗联合治疗。在这些病例中，辅助治疗均未因重建手术而延迟。从癌症诊断开始的总体平均随访时间为56.8个月，从TRAM瓣重建时开始为36.7个月。迄今为止，已检测到5例复发（6.6%）。重建与复发检测之间的平均时间为22.8个月。复发是通过临床检测到的，在任何病例中，游离皮瓣的存在均未影响复发的检测。通过电话调查评估患者满意度，93%的患者对手术的美容效果感到满意。
对于那些需要进行乳房切除的乳腺癌患者，游离TRAM瓣重建是一种安全、美容效果可接受的手术选择，既不影响有效的乳腺癌手术，也不影响复发性疾病的检测。
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