Li Nanlin, Zheng Zhao, Li Jipeng, Fan Jing, Wang Ting, Zhang Juliang, Wang Hui, Chen Jianghao, Lv Yonggang, Yi Jun, Huang Meiling, Ling Rui
Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
Medicine (Baltimore). 2017 Aug;96(33):e7797. doi: 10.1097/MD.0000000000007797.
Luminal subtype breast cancer, accounting for 70 to 80% of all breast cancers, has been reported to be associated with good prognosis. However, for the patients with large mass or worse mass position, omental flap transplantation may provide a new option for breast reconstruction.
Ten patients (6 luminal B1, 2 luminal B2, 2 luminal A), were enrolled into the study, between January 23, 2015 and August 22, 2016. The mean age was 34.6 ± 6.96 (24-44) years old. Immunohistochemistry demonstrated that the tumor cells were positive for estrogen receptor and progestrone receptor.
According to the clinicopathological features, diagnosis of breast cancer patients were made.
Breast-conserving surgery, laparoscopic greater omentum harvest and vascular anas-tomosis were carried out orderly. Postoperative operative results, cosmetic outcomes, complications, as well as blood supply were investigated for surgery evaluation. Reasonable chemotherapy and irradia-tion were adopted to patients according to the pathological condition.
We successfully accomplished breast reconstruction by omental flap transplantation, ex-cept one failed case because of the necrosis of omentum and changed to fat transplantation. The volumes and symmetry of breasts were all satisfied. The blood supply was detected to be fluent. Only one case of slight hematoma and another case of one distant metastasis were observed during fol-low-up period. No arm mordities or arm movement restriction occurred after surgery. Moreover, radia-tion therapy and chemotherapy had no clear effects on the reconstructed breast.
Immediate breast reconstruction surgery by transplanting omental flap for luminal breast cancer patients can be considered successful based on the excellent clinic outcome.
管腔型乳腺癌占所有乳腺癌的70%至80%,据报道其预后良好。然而,对于肿块较大或肿块位置不佳的患者,网膜瓣移植可能为乳房重建提供一种新的选择。
2015年1月23日至2016年8月22日期间,10例患者(6例管腔B1型、2例管腔B2型、2例管腔A型)纳入本研究。平均年龄为34.6±6.96(24 - 44)岁。免疫组化显示肿瘤细胞雌激素受体和孕激素受体呈阳性。
根据临床病理特征对乳腺癌患者进行诊断。
依次进行保乳手术、腹腔镜下大网膜采集及血管吻合。对手术效果、美容效果、并发症以及血供情况进行调查以评估手术。根据病理情况对患者采用合理的化疗和放疗。
我们通过网膜瓣移植成功完成了乳房重建,除1例因网膜坏死失败而改为脂肪移植外。乳房的体积和对称性均令人满意。检测血供通畅。随访期间仅观察到1例轻度血肿和另1例远处转移。术后未出现手臂畸形或手臂活动受限。此外,放疗和化疗对重建乳房无明显影响。
基于出色的临床结果,对于管腔型乳腺癌患者,通过网膜瓣移植进行即刻乳房重建手术可被认为是成功的。