探讨内窥镜辅助下切取钟摆形背阔肌肌皮瓣修复乳腺癌术后乳房缺损的临床效果。

2021年6月至2024年2月，空军军医大学第一附属医院烧伤与皮肤外科收治符合入选标准的乳腺癌术后乳房缺损患者9例，均为女性，年龄13~51岁。乳腺癌均未复发。其中假体植入后皮肤缺损4例，乳腺癌切除后乳房缺损5例。乳房皮肤软组织缺损面积为7.0 cm×4.0 cm~11.0 cm×7.5 cm。对患者进行清创后，于内窥镜辅助下切取钟摆形背阔肌肌皮瓣修复创面，供区创面一期缝合。术后常规行抗炎、抗凝、防止血管痉挛治疗，卧床制动，密切观察皮瓣血运情况。术后3 d拔除引流管，12~14 d拆线。随访观察创面愈合情况、乳房形态及肿瘤是否复发。

9例患者术后皮瓣均成活良好。术后随访6~12个月，随访期间未见乳腺癌复发患者。4例假体外露患者创面均已完全愈合，未出现假体再次外露。5例乳房缺损患者创面愈合良好，其中3例患侧乳房形态与健侧乳房存在一定差异。供区切口均愈合良好，仅1例出现明显瘢痕增生，经激光治疗后显著改善。供区横行切口形成的线性瘢痕可通过穿衣遮盖，外观影响较小。

内窥镜辅助下切取钟摆形背阔肌肌皮瓣修复乳腺癌术后乳房缺损，具有术中操作简便、供区美观、有利于假体保留并预防假体再次外露等优势，是一种安全且有效的手术方法。

To explore the clinical effect of the pendulum-shaped latissimus dorsi myocutaneous flap harvested with endoscopic assistance for repairing breast defects after surgery in breast cancer patients.

From June 2021 to February 2024，9 patients with breast defects after surgery who met the inclusion criteria were admitted to the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University. All patients were female，aged 13 to 51 years. The breast cancer had not recurred. Among them，4 cases had skin defects after breast implant placement，5 cases had breast defects after breast cancer resection. The area of breast skin soft tissue defect ranged from 7.0 cm × 4.0 cm to 11.0 cm × 7.5 cm. All patients underwent debridement and then received repair with a pendulum-shaped latissimus dorsi myocutaneous flap harvested with endoscopic assistance，and the donor area wounds were sutured in one stage. Postoperative anti-inflammatory，anticoagulation，and prevention of vascular spasm treatments were performed，and bed rest was required. Postoperatively，the blood supply of the flap was closely observed. The drainage tube was removed on postoperative day 3, and the sutures were removed 12-14 days after the operation. Observed the wound healing，breast shape，and whether the tumor recurred during follow-up.

The flaps of all 9 patients survived well after the operation. The postoperative follow-up period was 6 to 12 months. During the follow-up period，no cases of breast cancer recurrence were observed. For the 4 patients with exposed implants，the wounds had completely healed，and no implants re-exposure occurred. Among the 5 patients with breast defects，the wounds healed well，but there were certain differences in shape between the reconstructed and the contralateral breast in 3 cases. The incisions in the donor area healed well，and only 1 case had obvious scar hyperplasia，which was significantly improved after laser treatment. The linear scars formed by the transverse incision in the donor area could be covered by clothing，and the impact on appearance was slight.

The pendulum-shaped latissimus dorsi myocutaneous flap harvested with endoscopic assistance for repairing breast defects after surgery in breast cancer patients offers several advantages，including simple intraoperative operation，favorable aesthetic outcomes at the donor area，facilitation of implant retention，and prevention of implant re-exposure. It is a safe and effective surgical technique.