乳腺癌保乳术的手术技巧（附30例报告）

目的总结在乳腺癌保乳手术中，保持乳房良好外形应注意的问题和手术操作技巧。方法共对30例患者实行了乳腺癌保乳手术。术后从乳头外观、双乳头水平差距、双乳头距同侧腋前线垂直距离之差距和疤痕对乳房外形影响等四个方面的量化标准，评估保留乳房的外形美观效果。四项指标积分≥21分为优，13～20分为良，〈13分为差。结果术后评估乳房外形优良者26例（86.7％），乳房外形较差者4例（13.3％）。其中切口疤痕致乳房变形（1例）、乳头不自然挺立（1例）、与对侧乳头水平高度差距明显（1例），以及乳头歪斜（1例）是术后常见问题。结论术前手术切口的设计、术中皮瓣和保留乳腺组织的彻底游离及切除、缝合技巧，术后切口包扎注意避免压迫乳头等．有助于保留乳房外形的美观效果。

Objective To summarize the problems and techniques of conserving surgery for maintaining breast appearance of mammary cancer patients. Methods 30 patients had breast conserving surgery, postoperation breast appearance were evaluated for mammillary shape, plane difference of bilateral mammilla, the distance difference of bilateral mammillary to anterior axillary line, and scar influence. Results 26 patients（86.7%） got the good breast appearance after surgery, the other 4 （13.3%） got poor ones, main problems included breast distortion by scar, mammillary deflection, unnatural erected mammilla, and significant plane difference of bilateral mamillary. Conclusion Serious preoperation incision design, attention to skills of free skin flap and breast tissue in operation, and avoiding postoperation press on mammilla, would benefit maintaining the better breast appearance.