组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2025, Vol. 21 ›› Issue (3): 225-.

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自体皮瓣重建乳腺癌术后胸壁缺损的临床经验

  

  • 出版日期:2025-06-02 发布日期:2025-07-01

Clinical experience of autologous flap reconstruction of chest wall defects after breast cancer surgery

  • Online:2025-06-02 Published:2025-07-01

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摘要： 目的 探讨自体组织皮瓣移植重建局部晚期乳腺癌术后巨大胸壁缺损的方法和治疗效果。方法 回顾性分 析 2017年 1月至 2023年 11月治疗的 29例乳腺癌患者的临床资料，术前患者均接受新辅助治疗，均行乳腺癌扩大切除 联合自体皮瓣移植重建胸壁手术，观察患者手术相关指标及预后情况。结果 患者年龄 41~58（48.2±8.1）岁。乳腺浸 润性导管癌 19例，纤维上皮性肿瘤 5例，腺癌 3例，包裹性乳腺癌 2例。Luminal A型 14例，Luminal B型 7例，HER-2过 表达型3例，基底细胞型5例。患者住院时间（13.8±5.2） d，手术时长（4.6±1.6） h，术中平均出血（298.3±94.7） mL。肿块 面积6 cm×11 cm~26 cm×19 cm，修复软组织缺损皮瓣面积为13 cm×7 cm~22 cm×29 cm。应用局部皮瓣18例，带蒂背阔 肌肌皮瓣9例，横行腹直肌肌皮（TRAM）皮瓣1例，游离腹壁下动脉穿支（DIEP）皮瓣1例。合并胸骨或肋骨缺损8例，其 中7例无需钛网修复，1例应用钛网重建胸壁。29例患者术后胸壁功能正常27例，自体移植皮瓣坏死1例，自体皮瓣血 运障碍1例，坏死皮瓣经二期清创缝合后愈合。29例患者术后中位随访时间39个月，3年局部复发率和总生存率分别 为65.6%和34.4%。结论 局部晚期乳腺癌新辅助治疗后扩大切除肿瘤范围，采用自体皮瓣移植修复胸壁缺损，可以重 建胸壁功能，提高患者生活质量。

关键词: 乳腺肿瘤, &emsp, 自体皮瓣, &emsp, 胸壁重建, &emsp, 局部晚期乳腺癌

Abstract: Objective  To investigate the methods and therapeutic efficacy of autologous flap transplantation for reconstructing massive thoracic wall defects following radical resection of locally advanced breast cancer. Methods  A retrospective analysis was conducted on 29 breast cancer patients treated between January 2017 and November 2023. All patients underwent neoadjuvant therapy followed by extended tumor resection and autologous flap reconstruction. Surgical parameters and prognostic outcomes were evaluated. Results The patients， aged 41-58（ mean 48.2±8.1） years， included 19 cases of invasive ductal carcinoma， 5 fibroepithelial tumors， 3 adenocarcinomas， and 2 encapsulated breast cancers. Molecular subtypes comprised Luminal A（ 14 cases）， Luminal B（ 7 cases）， HER-2 overexpression（ 3 cases）， and basallike（ 5 cases）. Key outcomes included a mean hospital stay of（ 13.8±5.2） days， operative duration of（ 4.6±1.6） hours， and intraoperative blood loss of（ 298.3±94.7） mL. Tumor sizes ranged from 6 cm×11 cm to 26 cm×19 cm， with flap dimensions spanning 13 cm×7 cm to 22 cm×29 cm. Flap types included local flaps（ 18 cases）， pedicled latissimus dorsi myocutaneous flaps （9 cases）， transverse rectus abdominis myocutaneous （TRAM） flap （1 case）， and free deep inferior epigastric perforator （DIEP） flap （1 case）. There were 8 cases with combined sternum or rib defects. Among them， 7 cases did not require titanium mesh repair， and 1 case used titanium mesh to reconstruct the chest wall. Of the 29 patients， 27 had normal chest wall function， 1 had necrosis of autologous flap， and 1 had blood supply disorder of autologous flap. The necrotic flap healed after secondary debridement and suture. The median follow-up time for 29 patients after the operation was 39 months. The 3-year local recurrence rate and overall survival rate were 65.6% and 34.4%， respectively. Conclusion Autologous flap reconstruction after neoadjuvant therapy and extended resection effectively restores thoracic wall function and enhances quality of life in locally advanced breast cancer patients.

Key words: Breast neoplasm, &emsp, Autologous flap, &emsp, Chest wall reconstruction, &emsp, Locally advanced breast cancer