摘要
目的 观察1例乳腺癌患者行乳腺癌改良根治术后于腹腔镜辅助下获取大网膜同期行乳房重建术的疗效,探讨其安全性。方法 2023年5月29日河南省人民医院诊治左侧浸润性乳腺癌患者1例,女,40岁,于全身麻醉下切除左侧全乳及淋巴结清扫术后在腹腔镜辅助下行带蒂大网膜获取术,建立皮下大网膜组织转移通道并即刻将大网膜组织填充至胸壁皮瓣下重建乳房。记录患者手术情况,组织病理和免疫组织化学检查结果,术后观察重建乳房形态、质地等,记录住院期间大网膜瓣及脂肪坏死、供区牵拉感、切口疝、胸壁皮下气肿等并发症发生情况。结果 手术过程顺利,手术时间355 min,术中出血量50 mL,未输血及中转开腹。术后组织病理检查诊断为左乳及左腋窝浸润性癌,乳腺癌Scarff-Bloom-Richardson分级2级,伴导管原位癌,见明确脉管癌栓,皮肤切缘、底筋膜未见癌组织,左侧腋窝淋巴结(1/10)见癌组织,左侧中央区淋巴结未见癌组织,左侧外侧群淋巴结未见明确淋巴结组织,左锁骨下淋巴结(1/12)见癌组织。免疫组织化学检查显示雌激素受体>70%,孕激素受体>90%,人表皮生长因子受体-2阳性,Ki-67>15%。患者住院时间15 d,术后第2天复查血常规、肝肾功能、血电解质未见明显异常。术后未发生大网膜瓣及脂肪坏死、供区牵拉感、肠道功能障碍、切口疝、胸壁皮下气肿等并发症。术后重建乳房与健侧乳房对称,形态自然,呈自然弧度、下垂感,皮肤正常,触诊手感与健侧乳房相似,患者对重建乳房满意。结论 女性乳腺癌患者乳腺癌根治术后于腹腔镜辅助下获取带蒂大网膜同期重建乳房,具有手术创伤小、并发症少、乳房整形效果好的优势,安全可靠。
Objective To observe the clinical effect of immediate breast reconstruction with laparoscopically harvested pedicled greater omentum after modified radical mastectomy in one case,and to explore its safety.Methods A 40-year-old female patient with left invasive breast cancer was admitted to Henan Provincial People's Hospital on May 29,2023.After left whole breast resection and lymph node dissection under general anaesthesia,the pedicled greater omentum was harvest by laparoscopy.The subcutaneous omentum tissue transfer channel was established,and the omentum tissue was immediately filled into the chest wall flap to reconstruct the breast.The surgical procedures and histopathological results were recorded.The breast contour and texture were observed after operation,and the complications during hospital were recorded as omentum flap and fat necrosis,donor site traction,incisional hernia,and chest wall subcutaneous emphysema.Results The operation was performed smoothly in 355 min,with intraoperative blood loss of 50mL.There was no blood transfusion or conversion to open surgery.The postoperative histopathological examination confirmed invasive carcinoma in the left breast and left axilla with Scarff-Bloom-Richardson grade 2,which was complicated with ductal carcinoma in situ.Definite vascular tumour embolus was found.No cancer tissue was found in the skin incision margin and basal fascia.The left axillary lymph nodes(1/10),left central lymph nodes(0/2),left lateral group lymph nodes(0/2)and left subclavian lymph nodes(1/12) were found with cancer tissues.Immunohistochemical results showed estrogen receptor>70%,progesterone receptor>90%,human epidermal growth factor receptor 2positive and Ki-67>15%.The hospital stay was 15d,and there were no obvious abnormalities in blood routine,liver and kidney function and electrolytes on the second day after operation.The reconstructed breast of the patient was symmetrical to the healthy side,with natural shape,natural curvature and ptosis of the breast,and normal skin.The touch o
作者
田雨
刘继全
马赫男
陈海军
韩智培
毛雅楠
王赟霞
李文涛
TIAN Yu;LIU Jiquan;MA Henan;CHEN Haijun;HAN Zhipei;MAO Yanan;WANG Yunxia;LI Wentao(Department of Breast Surgery,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China;Department of Breast Surgery,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Anesthesiology and Perioperative Medicine,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2023年第7期739-742,共4页
Journal of Chinese Practical Diagnosis and Therapy
关键词
乳腺癌
改良根治术
腹腔镜
带蒂大网膜
乳房重建术
breast cancer
modified radical mastectomy
laparoscopy
pedicled greater omentum
breast reconstruction
