背阔肌加假体乳房再造术在乳腺癌根治术后的应用价值(1)
[摘要]目的：探讨在乳腺癌术后一期再造术中应用背阔肌加假体乳房再造术的临床治疗效果。方法：选取笔者医院2014年1月-2018年2月107例乳腺癌患者，并随机分为两组，对照组采用常规治疗根治术，观察组采用背阔肌加假体乳房再造术。观察两组患者术后治疗效果和美容效果。结果：对照组和观察组的生存质量分别为(62.3±5.7)分和(79.3±8.4)分，差异有统计学意义(t=-12.180，P=0.000)。观察组并发症发生率为10.3%低于对照组的22.3%，差异有统计学意义(χ2=3.912，P=0.048)。观察组优良率为92.7%高于对照组的84.6%，差异有统计学意义(χ2=4.322，P=0.034)。结论：在乳腺癌术后采用背阔肌加假体乳房再造术后乳房形态良好，具有较高的修复价值。
[关键词]乳腺癌；背阔肌；乳房再造术；假体；根治术
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)12-0034-02
, http://www.100md.com
Application of Latissimus Dorsi and Prosthesis Breast Reconstruction in Postoperative Breast Cancer
CHEN Jing-jing
[Department of Breast Surgery，Tangshan City People's Hospital (Tangshan City Tumor Hospital)，Tangshan 063000，Hebei，China]
Abstract： Objective To investigate the clinical effect of latissimus dorsi muscle augmentation with breast reconstruction in the primary reoperation of breast cancer. Methods 107 patients with breast cancer were randomly divided into two groups. from January 2014 to February 2018. The control group were received conventional radical mastectomy. The observation group were receivedlatissimus dorsi plus prosthetic breast reconstruction. Compared the postoperative treatment effect and cosmetic effect of the two groups. Results The quality of life of the control group and the observation group were (62.3±5.7) and (79.3±8.4)， respectively， the difference was statistically significant(t=-12.180，P=0.000). The complication rate in the observation group was 10.3%， which was lower than that in the control group(22.3%， χ2=3.912， P=0.048). The excellent and good rate of the observation group was 92.7%， which was higher than that of the control group(84.6%， χ2=4.322， P=0.034). Conclusion The breast morphology after latissimus dorsi muscle reconstruction plus breast prosthesis after breast cancer surgery has high repair value.
, 百拇医药
Key words： breast cancer； latissimus dorsi； breast reconstruction； prosthesis； radical correction
乳腺癌是一種常见的妇科癌症，患者一旦患有乳腺癌，会发生乳腺肿块，乳头溢血，乳头异常等症状，给患者的生命健康带来巨大影响[1-2]。该疾病若在早期采取手术会达到较好的治疗效果，通过手术切除方法治疗乳腺癌是常见的治疗手段[3-4]。术后因乳房切除会给患者的形态造成一定影响，可能会对患者的心理造成较大影响。故为了减少术后患者出现心理疾病，术后乳房再造术的应用越来越广泛，通过乳房再造术可以保证乳房的完整性，利于患者心理康复[5-6]。本研究探讨背阔肌加假体行乳房再造术对乳腺癌患者术后的临床治疗效果，现报道如下。
1 资料和方法
1.1 一般资料：选取笔者医院2014年1月-2018年2月107例乳腺癌患者，并随机分为两组，对照组52例，平均(35.32±5.93)岁；观察组55例，平均(36.87±6.09)岁。纳入标准：①临床确诊为乳腺癌者；②处于乳腺癌Ⅰ期者；③未患有糖尿病等代谢异常类疾病者；④无其他乳腺疾病者。两组患者年龄、病程等一般临床资料比较，差异无统计学意义(P>0.05)，具有可比性。所有患者均知悉临床方案，签署知情同意书，本研究得到医院伦理委员会批准。
1.2 手术方法：对照组采用常规治疗方法，即采取乳腺癌根治术，未行乳房再造术。观察组行全身麻醉，乳腺癌根治术后进行乳房再造术。术前观察患者胸部皮肤、软组织缺损情况，设置手术切口位置和背阔肌肌皮瓣形状大小，皮肤缺损处可用皮瓣修复，腋前和锁骨下凹陷可用背阔肌和皮下脂肪组织填充。从腋下作一切口，同时沿背阔肌前缘向下切开，当切口到肌膜后将背阔肌肌膜显露出来，切断肌肉在腰背部的附着点(蒂部除外)，将肌皮瓣通过腋下和锁骨下方的皮下隧道转移到前胸，该肌皮瓣和蒂部皮下组织同时填充腋前和锁骨下凹陷。在背阔肌皮瓣下置入假体，假体下缘可低于健侧乳房下皱襞，同时将假体外围肌瓣和胸壁缝合[7-8]。, 百拇医药(陈晶晶)
[关键词]乳腺癌；背阔肌；乳房再造术；假体；根治术
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)12-0034-02
, http://www.100md.com
Application of Latissimus Dorsi and Prosthesis Breast Reconstruction in Postoperative Breast Cancer
CHEN Jing-jing
[Department of Breast Surgery，Tangshan City People's Hospital (Tangshan City Tumor Hospital)，Tangshan 063000，Hebei，China]
Abstract： Objective To investigate the clinical effect of latissimus dorsi muscle augmentation with breast reconstruction in the primary reoperation of breast cancer. Methods 107 patients with breast cancer were randomly divided into two groups. from January 2014 to February 2018. The control group were received conventional radical mastectomy. The observation group were receivedlatissimus dorsi plus prosthetic breast reconstruction. Compared the postoperative treatment effect and cosmetic effect of the two groups. Results The quality of life of the control group and the observation group were (62.3±5.7) and (79.3±8.4)， respectively， the difference was statistically significant(t=-12.180，P=0.000). The complication rate in the observation group was 10.3%， which was lower than that in the control group(22.3%， χ2=3.912， P=0.048). The excellent and good rate of the observation group was 92.7%， which was higher than that of the control group(84.6%， χ2=4.322， P=0.034). Conclusion The breast morphology after latissimus dorsi muscle reconstruction plus breast prosthesis after breast cancer surgery has high repair value.
, 百拇医药
Key words： breast cancer； latissimus dorsi； breast reconstruction； prosthesis； radical correction
乳腺癌是一種常见的妇科癌症，患者一旦患有乳腺癌，会发生乳腺肿块，乳头溢血，乳头异常等症状，给患者的生命健康带来巨大影响[1-2]。该疾病若在早期采取手术会达到较好的治疗效果，通过手术切除方法治疗乳腺癌是常见的治疗手段[3-4]。术后因乳房切除会给患者的形态造成一定影响，可能会对患者的心理造成较大影响。故为了减少术后患者出现心理疾病，术后乳房再造术的应用越来越广泛，通过乳房再造术可以保证乳房的完整性，利于患者心理康复[5-6]。本研究探讨背阔肌加假体行乳房再造术对乳腺癌患者术后的临床治疗效果，现报道如下。
1 资料和方法
1.1 一般资料：选取笔者医院2014年1月-2018年2月107例乳腺癌患者，并随机分为两组，对照组52例，平均(35.32±5.93)岁；观察组55例，平均(36.87±6.09)岁。纳入标准：①临床确诊为乳腺癌者；②处于乳腺癌Ⅰ期者；③未患有糖尿病等代谢异常类疾病者；④无其他乳腺疾病者。两组患者年龄、病程等一般临床资料比较，差异无统计学意义(P>0.05)，具有可比性。所有患者均知悉临床方案，签署知情同意书，本研究得到医院伦理委员会批准。
1.2 手术方法：对照组采用常规治疗方法，即采取乳腺癌根治术，未行乳房再造术。观察组行全身麻醉，乳腺癌根治术后进行乳房再造术。术前观察患者胸部皮肤、软组织缺损情况，设置手术切口位置和背阔肌肌皮瓣形状大小，皮肤缺损处可用皮瓣修复，腋前和锁骨下凹陷可用背阔肌和皮下脂肪组织填充。从腋下作一切口，同时沿背阔肌前缘向下切开，当切口到肌膜后将背阔肌肌膜显露出来，切断肌肉在腰背部的附着点(蒂部除外)，将肌皮瓣通过腋下和锁骨下方的皮下隧道转移到前胸，该肌皮瓣和蒂部皮下组织同时填充腋前和锁骨下凹陷。在背阔肌皮瓣下置入假体，假体下缘可低于健侧乳房下皱襞，同时将假体外围肌瓣和胸壁缝合[7-8]。, 百拇医药(陈晶晶)
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