乳腔镜辅助下行乳腺癌皮下腺体切除Ⅰ期假体植入术20例报告

The application of endoscopy-assisted subcutaneous mastectomy and immediate mammary prosthesis reconstruction

目的:探讨乳腔镜辅助下行乳腺癌皮下腺体切除、Ⅰ期假体植入术的可行性。方法:2005年12月～2007年10月经TE或CEX方案新辅助化疗2～6周期后的乳腺癌患者20例,Ⅰ期8例,Ⅱ期10例,Ⅲ期2例,其中10例Ⅱ期患者4例降为Ⅰ期,2例Ⅲ期降为Ⅱ期。在乳腔镜辅助下行保留乳头乳晕区的皮下腺体切除,Ⅰ期将假体植入胸大肌、胸小肌之间。根据术中冰冻决定是否保留乳头乳晕复合体。结果:20例中1例行双侧乳腺皮下切除,19例行单侧乳腺皮下切除术,均保留乳头乳晕复合体,Ⅰ期假体植入。腋窝淋巴结清扫17例,9例行前哨淋巴结活检,保腋窝3例。17例患者效果满意,2例效果一般,1例感觉差。1例皮瓣坏死,2例发生皮下积液,1例乳头皮肤部分坏死。随访3～22.5个月,中位随访12.6个月,未见局部复发及远处转移。结论:应用乳腔镜辅助下行乳腺癌皮下腺体切除、Ⅰ期假体植入具有微创、美容效果。双侧乳房皮下腺体切除、Ⅰ期假体植入效果更佳。

Objective：To explore the feasibility of endoscopy-assisted subcutaneous mastectomy and immediate mammary prosthesis reconstruction.Methods：From December 2005 to October 2007,20 breast cancer patients underwent endoscopy-assisted skin sparing mastectomy and immediate implanting breast reconstruction,which were preoperatively performed systemic TE or CEX chemotherapy two to six times.Whether or not the Nipple-areola complexes were preserved depended on the results of freeze pathological examination.Results：Of 20 patients,bilateral skin sparing mastectomy were performed in one patient,and others underwent single lateral mastectomy with the Nipple-areola complexes,in the same time sentinel lymph node biopsy was done in 9 patients.Combined level Ⅰand Ⅱ axillary dissections were carried out via the same incisions under the axillaries in 17 patients,and 3 patients spared axillary dissections.17 of them got satisfactory results,two patients felt fair and one patient felt equation.The postoperation complication included subcutaneous seroma 2 cases,a part of the nipple＇s skin necrosis 1 case and skin flap necrosis 1 case.No local recurrence occurred in the patients during the follow-up time ranged 3-22.5 months.Conclusion：It is technically safe and feasible that endoscopy-assisted subcutaneous mastectomy with immediate mammary prosthesis reconstruction.The technique can minimize skin incision with little trauma,and offers a greater esthetic advantage to most patients.