Fung K W, Lau Y, Nyunt K, Chan C M, Ho C M
Department of Surgery, Kwong Wah Hospital, Hong Kong.
Aust N Z J Surg. 1996 Jul;66(7):452-6. doi: 10.1111/j.1445-2197.1996.tb00781.x.
Total mastectomy remains the mainstay of operative treatment for breast cancer mainly because it is preferred by surgeons. The techniques and benefits of reconstructing the amputated breast have been well documented in the medical literature but there have been very few reports on this issue in Chinese women. Immediate breast reconstruction using the transverse rectus abdominis myocutaneous (TRAM) flap in Chinese women suffering from early breast cancer who require mastectomy is summarized.
Since September 1991, the option of immediate breast reconstruction was offered to all patients less than 60 years of age suffering from early cancer (Tis, T1 or T2) who were not suitable for breast-conserving treatment or who preferred to have a mastectomy. The single-pedicled TRAM flap was used.
From September 1991 to September 1994, 27 reconstructions were performed. Partial flap loss occurred in four patients (15%), fat necrosis in three patients (11%) and abdominal bulging in one patient (4%). Operations performed by two teams simultaneously reduced operating time by 1.5 h without increasing the risk of complications. Twenty-one patients (78%) were satisfied or very satisfied with the outcome of reconstruction.
The TRAM flap is a satisfactory method of breast reconstruction in Chinese women. A two-team approach can be employed safely to shorten operative time. Overall patient satisfaction was high.
全乳切除术仍是乳腺癌手术治疗的主要方式，主要原因是外科医生更倾向于采用这种方法。乳房切除术后乳房重建的技术和益处已在医学文献中得到充分记载，但关于中国女性这一问题的报道却很少。本文总结了对早期乳腺癌且需要进行乳房切除的中国女性采用腹直肌肌皮瓣（TRAM瓣）进行即刻乳房重建的情况。
自1991年9月起，为所有年龄小于60岁、患有早期癌症（Tis、T1或T2）且不适合保乳治疗或更倾向于接受乳房切除术的患者提供即刻乳房重建选择。采用单蒂TRAM瓣。
1991年9月至1994年9月，共进行了27例重建手术。4例患者（15%）出现部分皮瓣坏死，3例患者（11%）出现脂肪坏死，1例患者（4%）出现腹部膨隆。两个手术团队同时进行手术可减少手术时间1.�小时，且不增加并发症风险。21例患者（78%）对重建效果满意或非常满意。
TRAM瓣是中国女性乳房重建的一种令人满意的方法。可以安全地采用双团队方法来缩短手术时间。患者总体满意度较高。
