乳腔镜辅助保留乳头乳腺癌改良根治术的临床研究

Mastoscopy assisted nipple conserving modified radical mastectomy in treatment of breast cancer

目的：探讨乳腔镜辅助保留乳头乳腺癌改良根治术的近期疗效。方法：对46例肿块直径≤3 cm、距离乳晕≥3 cm的乳腺癌患者施行乳腔镜辅助保留乳头乳腺癌改良根治术。腋窝脂肪抽吸后经乳腔镜行腋窝淋巴清除。彩色多普勒（探头频率10 MHz）测量患者双侧胸大肌厚度。测量前臂屈曲至胸前上臂尽力内收的角度,以评价上肢功能。结果：手术时间120～156 min（平均125 min）,术中出血量30～100 mL（平均58 mL）,术后引流量10～200 mL（平均92 mL）,引流时间3～7 d（平均4 d）,清除腋窝淋巴结6～35枚（平均16.3枚）。17例患者腋窝淋巴结阳性,平均受累淋巴结数为2.6。保留的乳头形态良好,伤口小而隐蔽,术后双侧胸大肌厚度及上肢内收角度差别差异均无统计学意义,t=1.68,P〉0.05。所有患者对手术效果满意。术后随访2～41个月,平均16.1个月,未见局部肿瘤复发及腋窝和远处转移。结论：乳腔镜辅助保留乳头乳腺癌改良根治术并发症少,具有微创、临床易行、功能保护和美容兼具的特点,还可以保护上肢功能,保持胸部良好的外观形状及提高患者的生存质量,是一种治疗Ⅰ、Ⅱ期乳腺癌合理有效的术式。

OBJECTIVE： To explore the recent effect of mastoscopy assisted nipple conserving modified radical mastectomy in the treatment of breast cancer.METHODS： Following the liposuction of the axilla,axillary lymph node dissection was performed in 46 patients with breast cancer of a diameter ≤3 cm,and a distance ≥3 cm from the mammary areola to tumor by mastoscopy assisted nipple conserving modified radical mastectomy.The thickness of musculus pectoral major of both sides was measured in 46 patients after the operation of breast cancer by colour Doppler（10 MHz）.Upper extremities adducent angles were measured at the same time.RESULTS： The duration of operation was from 120 to 156 min with a median of 125 mins.The bleeding amount in operation was from 30 to 100 mL with a median of 58 mL.The drainage liquid was from 10 to 200 mL with a median of 92 mL.A mean number of 16.3（6-35） lymph nodes were harvested.Seventeen patients showed involved lymph nodes.The mean number of involved lymph nodes in these patients was 2.6.Excellent cosmetic outcomes were obtained with symmetrical breast development and all patients were satisfied with the treatment.The thickness of musculus pectoral major and adducent angle of affected side had significant differences compared with the health side,t=1.68,P〉0.05.After postoperative follow-up for 2-41 months（median 16.1 months）,no regional recurrence in the breast and the axillary fossa or distant metastasis was found.CONCLUSIONS： Mastoscopy assisted nipple conserving modified radical mastectomy can protect the function of upper limb,maintain the favorable appearance of bosom,and improve the living quality of the patients with breast cancer.Mastoscopic operation is a minimally invasive and clinical feasible procedure.It manifests the functional and cosmetic effects and satisfies the breast cancer patients to certain extent.So mastoscopic operation may be a reasonable method to cure breast cancer of phase Ⅰ and Ⅱ.