Zhang B, Wang Y, Zhang K T, Guan S
Breast Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China.
Zhonghua Wai Ke Za Zhi. 2023 Feb 1;61(2):114-119. doi: 10.3760/cma.j.cn112139-20220510-00212.
To examine the application of volume replacement techniques in breast conserving surgery for breast cancer. The clinic data of 76 breast cancer patients underwent a breast conserving surgery with volume replacement techniques at the Breast Center, Beijing Tongren Hospital, from June 2019 to June 2021 were analyzed retrospectively. All patients were female, aged (42.6±6.4) years (range: 32 to 56 years). Tumor staging inlcuded stage ⅡA in 36 cases, stage ⅡB in 24 cases, stage ⅢA in 12 cases, stage ⅢB in 4 cases. Three types of techniques included the lateral thoracic adipofascial flaps in 47 cases, the upper abdominal wall adipofascial flaps in 22 cases and the latissimus dorsi myocutaneous flap in 7 cases. The specimen volume of tumor expansion resection in breast conserving surgery was measured, while the operative time used for volume replacement techniques, postoperative drainage retention time, postoperative complications and patients' satisfaction with the breast shape were recorded. The specimen volume of tumor was (100.9±24.2) ml (range: 55 to 157 ml) in lateral thoracic adipofascial flap group, (88.4±14.5) ml (67 to 118 ml) in upper abdominal wall adipofascial flap group, (179.7±22.9) ml (range: 155 to 220 ml) in latissimus dorsi myocutaneous flap group. The operative time used to restore the breast shape of the three groups were (52.9±9.0) minutes (range: 45 to 70 minutes), (63.2±8.8) minutes (range: 50 to 70 minutes) and (99.3±3.4) minutes (range: 95 to 105 minutes), respectively. The postoperative drainage retention times of the three groups were (8.6±1.2) days (range: 7 to 10 days), (9.4±0.9) days (range: 8 to 10 days) and (11.4±1.3) days (range: 10 to 13 days), respectively. All the 76 patients were evaluated for their satisfaction with the cosmetic outcomes, 64 patients (84.2%) were strongly satisfied and 12 patients (15.8%) were generally satisfied. The postoperative complications included fat liquefaction in 6 cases (2 cases in the lateral thoracic adipofascial flap group and 4 cases in the upper abdominal adipofascial flap group) and seroma in 4 cases (each 2 cases in the lateral thoracic adipofascial flap group and the latissimus dorsi myocutaneous flap group). For patients with large tissue loss during breast conserving surgery, the corresponding volume replacement techniques, including lateral thoracic adipofascial flaps, upper abdominal wall adpofascial flaps and latissimus dorsi myocutaneous flaps, should be reasonably selected for repair according to the tumor site and the size of the intraoperative breast loss, which can ensure the original volume and shape of the breast, with controllable postoperative complications.
探讨容积替代技术在乳腺癌保乳手术中的应用。回顾性分析2019年6月至2021年6月在北京同仁医院乳腺中心接受容积替代技术保乳手术的76例乳腺癌患者的临床资料。所有患者均为女性，年龄（42.6±6.4）岁（范围：32至56岁）。肿瘤分期包括ⅡA期36例、ⅡB期24例、ⅢA期12例、ⅢB期4例。三种技术包括胸外侧脂肪筋膜瓣47例、上腹壁脂肪筋膜瓣22例、背阔肌肌皮瓣7例。测量保乳手术中肿瘤扩大切除的标本体积，记录容积替代技术的手术时间、术后引流保留时间、术后并发症及患者对乳房外形的满意度。胸外侧脂肪筋膜瓣组肿瘤标本体积为（100.9±24.2）ml（范围：55至157 ml），上腹壁脂肪筋膜瓣组为（88.4±14.5）ml（67至118 ml），背阔肌肌皮瓣组为（179.7±22.9）ml（范围：155至220 ml）。三组恢复乳房外形的手术时间分别为（52.9±9.0）分钟（范围：45至70分钟）、（63.2±8.8）分钟（范围：50至70分钟）和（99.3±3.4）分钟（范围：95至105分钟）。三组术后引流保留时间分别为（8.6±1.2）天（范围：7至10天）、（9.4±0.9）天（范围：8至10天）和（11.4±1.3）天（范围：10至13天）。对76例患者的美容效果满意度进行评估，64例（84.2%）非常满意，12例（15.8%）一般满意。术后并发症包括脂肪液化6例（胸外侧脂肪筋膜瓣组2例、上腹壁脂肪筋膜瓣组4例）和血清肿4例（胸外侧脂肪筋膜瓣组和背阔肌肌皮瓣组各2例）。对于保乳手术中组织损失较大的患者，应根据肿瘤部位及术中乳房缺失大小合理选择相应的容积替代技术，包括胸外侧脂肪筋膜瓣、上腹壁脂肪筋膜瓣和背阔肌肌皮瓣进行修复，可保证乳房的原有体积和外形，术后并发症可控。
