DIEP皮瓣与背阔肌肌皮瓣再造一侧乳房时对侧乳房处理的比较(1)
[摘要]目的:探讨DIEP(腹壁下动脉穿支,deep inferior epigastic perforator,简称DIEP)皮瓣与背阔肌肌皮瓣再造一侧乳房时对侧乳房处理策略的比较。方法:2006年7月至2009年10月,选取15例保留乳头乳晕的乳癌改良根治术和10例Poland综合征的患者,其中12例行一侧DIEP皮瓣再造,余13例行一期背阔肌肌皮瓣转移并植入扩张器,术前对侧乳房下垂,3～5个月后二期乳房行假体置换扩张器,如双侧乳房不对称,同时进行对侧乳房的乳房缩小处理,期望能达到两侧对称性。结果:10例DIEP再造的乳房与对侧基本对称,另外2例要求二期修整。13例背阔肌肌皮瓣要求处理对侧下垂乳房,经处理后,与DIEP再造乳房相比,对称性仍感不足。 结论:与DIEP乳房再造相比,背阔肌肌皮瓣乳房再造之后为了达到两侧乳房对称,处理对侧乳房是必要的。
[关键词]DIEP;背阔肌;乳房再造;单侧;对侧;皮瓣
[中图分类号]R655.8 [文献标识码]A[文章编号]1008-6455(2010)06-0810-03
To explore contrast in contralateral breast management when unilateral breast was reconstructed between DIEP flap and lattisimus dorse muscle
CHEN Bao-guo,QIAO Qun,HUANG Wei-qing,ZHANG Hai-lin,ZHU Lin
(Department of Plastic Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Beijing 100032,China)
Abstract:ObjectiveTo explore contrast in contralateral breast management when unilateral breast was reconstructed between DIEP(deep inferior epigasric perferators) flap and lattisimus dorse muscle flap. MethodsFrom Jul.2006 to Oct.2009,15 cases with modified radical mastectomy and 10 cases with Poland's syndrome were choosed.In between,12 cases undergone DIEP transplantation for unilateral breast reconstruction.The remaining 13 cases received lattisimus dorse muscle shift and expander implantation. Contralateral breast drooped preoperatively.After 3 to 5 months,the expander was replaced with implant.If bilateral breasts had no symmetry, the drooped breast was treated with reduction procedure,which is expected to realize symmetry.Results10 cases with DIEP breast reconstruction had general symmetrical with the contralateral breast,when another 2 cases requested secondary modification.All 13 cases with lattisimus dorse muscle breast reconstruction had requested operation for the contralateral breast management.Even with modification,the symmetry did not meet our expectation when it was compared to DIEP performance.Conclusions Compared to DIEP flap breast reconstruction, contralateral breast dealment is needed with lattisimus dorse muscle breast reconstruction so as to obtain bilateral breast symmetry
Key words:DIEP;lattisimusdorsemuscle;breast reconstruction;unilateral;contra-lateral;flap
乳癌术后单侧乳房的重建与对侧乳房不对称,对患者的心理是 一种打击,也是临床上的难点所在,2006年7月～2009年10月,笔者对术前乳房下垂或肥大的患者,乳癌术后患者行DIEP(腹壁下动脉穿支,deep inferior epigastic perferatof,DIEP)再造或者行背阔肌肌皮瓣单侧乳房再造,如双侧乳房不一致,进行了对侧乳房的缩小整形处理。
1一般资料
本组25例患者,50侧乳房,年龄25～40岁,正常侧乳房下垂II度～III度,对侧为乳癌或乳房先天缺失的患者。
2手术方法
2.1 术前设计:患者术前取坐位或立位。乳腺外科先行设计的梭形切口边缘两侧距肿块边缘3cm,梭形长轴根据肿块的不同部位和形状而旋转。背部切口的形状用纸片印模乳房来复制拟切除皮肤的形状和大小。胸前和背部皮岛的形状和纵轴方向在胸背角内大致相对称。背部皮肤在乳房切除皮肤面积的基础上放大5%～10%。皮瓣的上顶到腋窝的距离要稍长于乳房切除皮瓣的上顶到腋窝的距离。使皮瓣转移后无张力。设计DIEP前,通过增强CT确定穿支,按照对侧乳房的大小,设计单蒂或双蒂DIEP皮瓣。
2.2 由乳腺外科行前胸壁的乳腺癌改良根治术:剥离皮瓣时,皮下留一些脂肪组织(约3 mm厚)。乳头和乳晕下的脂肪组织稍厚一些,以防乳头缺血坏死,清除乳头和乳晕下的乳腺组织。腋窝清扫时保护胸背动、静脉,并预先解剖背阔肌周围组织.尽可能显露胸背动、静脉至所要切除之背阔肌的部位,为背部手术作准备。
2.3 背部肌皮瓣的切取和转移及放置扩张器:改变体位为侧卧,按照术前设计的皮岛切口线切开,在腋窝处作一横形约3cm的切口,向上、向下先分别剥离背阔肌浅面,再剥离背阔肌深面,近腋窝处注意保护胸背血管和神经,将带蒂背阔肌完全游离后,打通隧道,使背阔肌转移平铺在胸部,缝合后背切口并放置引流管2根。恢复为仰卧位,于近腋窝处胸大小肌间分离其间隙,下端至术前设计的乳房下皱襞标记线.内侧至近胸骨处,分离恰当的间隙,要恰能放选择之假体或扩张器的大小,先缝合固定背阔肌下端,再将假体或者扩张器置入。, 百拇医药(陈保国,乔 群,黄渭清,张海林,朱 琳)
[关键词]DIEP;背阔肌;乳房再造;单侧;对侧;皮瓣
[中图分类号]R655.8 [文献标识码]A[文章编号]1008-6455(2010)06-0810-03
To explore contrast in contralateral breast management when unilateral breast was reconstructed between DIEP flap and lattisimus dorse muscle
CHEN Bao-guo,QIAO Qun,HUANG Wei-qing,ZHANG Hai-lin,ZHU Lin
(Department of Plastic Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Beijing 100032,China)
Abstract:ObjectiveTo explore contrast in contralateral breast management when unilateral breast was reconstructed between DIEP(deep inferior epigasric perferators) flap and lattisimus dorse muscle flap. MethodsFrom Jul.2006 to Oct.2009,15 cases with modified radical mastectomy and 10 cases with Poland's syndrome were choosed.In between,12 cases undergone DIEP transplantation for unilateral breast reconstruction.The remaining 13 cases received lattisimus dorse muscle shift and expander implantation. Contralateral breast drooped preoperatively.After 3 to 5 months,the expander was replaced with implant.If bilateral breasts had no symmetry, the drooped breast was treated with reduction procedure,which is expected to realize symmetry.Results10 cases with DIEP breast reconstruction had general symmetrical with the contralateral breast,when another 2 cases requested secondary modification.All 13 cases with lattisimus dorse muscle breast reconstruction had requested operation for the contralateral breast management.Even with modification,the symmetry did not meet our expectation when it was compared to DIEP performance.Conclusions Compared to DIEP flap breast reconstruction, contralateral breast dealment is needed with lattisimus dorse muscle breast reconstruction so as to obtain bilateral breast symmetry
Key words:DIEP;lattisimusdorsemuscle;breast reconstruction;unilateral;contra-lateral;flap
乳癌术后单侧乳房的重建与对侧乳房不对称,对患者的心理是 一种打击,也是临床上的难点所在,2006年7月～2009年10月,笔者对术前乳房下垂或肥大的患者,乳癌术后患者行DIEP(腹壁下动脉穿支,deep inferior epigastic perferatof,DIEP)再造或者行背阔肌肌皮瓣单侧乳房再造,如双侧乳房不一致,进行了对侧乳房的缩小整形处理。
1一般资料
本组25例患者,50侧乳房,年龄25～40岁,正常侧乳房下垂II度～III度,对侧为乳癌或乳房先天缺失的患者。
2手术方法
2.1 术前设计:患者术前取坐位或立位。乳腺外科先行设计的梭形切口边缘两侧距肿块边缘3cm,梭形长轴根据肿块的不同部位和形状而旋转。背部切口的形状用纸片印模乳房来复制拟切除皮肤的形状和大小。胸前和背部皮岛的形状和纵轴方向在胸背角内大致相对称。背部皮肤在乳房切除皮肤面积的基础上放大5%～10%。皮瓣的上顶到腋窝的距离要稍长于乳房切除皮瓣的上顶到腋窝的距离。使皮瓣转移后无张力。设计DIEP前,通过增强CT确定穿支,按照对侧乳房的大小,设计单蒂或双蒂DIEP皮瓣。
2.2 由乳腺外科行前胸壁的乳腺癌改良根治术:剥离皮瓣时,皮下留一些脂肪组织(约3 mm厚)。乳头和乳晕下的脂肪组织稍厚一些,以防乳头缺血坏死,清除乳头和乳晕下的乳腺组织。腋窝清扫时保护胸背动、静脉,并预先解剖背阔肌周围组织.尽可能显露胸背动、静脉至所要切除之背阔肌的部位,为背部手术作准备。
2.3 背部肌皮瓣的切取和转移及放置扩张器:改变体位为侧卧,按照术前设计的皮岛切口线切开,在腋窝处作一横形约3cm的切口,向上、向下先分别剥离背阔肌浅面,再剥离背阔肌深面,近腋窝处注意保护胸背血管和神经,将带蒂背阔肌完全游离后,打通隧道,使背阔肌转移平铺在胸部,缝合后背切口并放置引流管2根。恢复为仰卧位,于近腋窝处胸大小肌间分离其间隙,下端至术前设计的乳房下皱襞标记线.内侧至近胸骨处,分离恰当的间隙,要恰能放选择之假体或扩张器的大小,先缝合固定背阔肌下端,再将假体或者扩张器置入。, 百拇医药(陈保国,乔 群,黄渭清,张海林,朱 琳)