保留皮肤的全乳切除加一期假体乳房再造在早期乳腺癌患者中的临床应用评价

Clinical application evaluation of skin sparing mastectomy with immediate reconstruction by using of implant in patients with early breast carcinoma

目的通过与传统乳腺癌改良根治术(MRM)、保乳手术(BCS)进行比较,分析评价保留皮肤的全乳切除(SSM)加一期假体再造在早期乳腺癌患者中的临床应用价值。方法选择解放军总医院第一附属医院普外科2000年5月～2010年5月收治的早期初治乳腺癌(0、Ⅰ期)患者151例。其中行SSM术者42例为SSM组,行MRM术者58例为MRM组,行BCS术者51例为BCS组。SSM组中有30例得以保留乳头乳晕复合体(NAC)。对三组患者的手术时间、失血量、术后并发症、审美评价及局部复发进行对比分析。结果 SSM组手术时间为(95.0±36.5)min,BCS组为(85.5±20.5)min,与MRM组(31.0±10.5)min比较差异有统计学意义(P<0.05);BCS组失血量少于SSM组及MRM组(P<0.05);三组血肿、感染、皮瓣缺血等方面比较,差异均无统计学意义(P>0.05);SSM组术后血清肿发生率高于MRM组及BCS组(P<0.05);SSM组与BCS组的审美评价无统计学差异(P>0.05),均好于MRM组(P<0.05);三组151例患者均获随访,随访时间2.5～10.0年,平均随访5.5年,随访期间SSM组与MRM组局部复发率差异无统计学意义(P>0.05),但均低于BCS组(P<0.05)。结论 SSM加一期假体乳房重建是早期乳腺癌患者可选择的有效治疗措施,具有安全、审美效果好等优点。

Objective To analyze and evaluate clinical efficacy of skin sparing mastectomy with immediate reconstruc tion by using implant in early breast carcinoma in comparison with traditional modified radical mastectomy and breast conserving surgery.Methods 151 patients with early stage（0 or Ⅰ stage） breast cancer from May 2000 to May 2010 in the First Affiliated Hospital of PLA General Hospital were selected.58 patients undergoing modified radical mastec tomy（MRM） were chosen as MRM group,51 patients undergoing breast conserving surgery（BCS） were chosen as BCS group,and 42 patients undergoing skin sparing mastectomy（SSM） were chosen as SSM group.30 cases were treated with NAC in SSM group.Operative time,blood loss,postoperative complications,aesthetic assessment,local recurrence were compared.Results Operative time in SSM group were（95.0±36.5） min,operative time in BCS group were（85.5 ± 20.5） min,they were found with statistically significant differences with MRM group（31.0 ±10.5） min（P〈0.05）.Blood loss in BCS group were lower than those in MRM group and SSM group（P〈0.05）.The difference of hematoma,infection,skin flap of ischemia in 3 groups was not statistically significant（P〈0.05）;incidence of seroma in SSM group were higher than those in BCS group and MRM group（P〈0.05）.The difference of aesthetic evaluation in SSM group and BCS group was not statistically significant（P〈0.05）,they were all better than those in MRM group（P〈0.05）.Follow-up was obtained in all patients with range of 2.5 to 10.0 years,averaging was 5.5 years.The incidences of lo cal recurrence in SSM group and MRM group was found with no statistically significant difference（P〈0.05）,but was lower than that in BCS group（P〈0.05）.Conclusion SSM with immediate reconstruction by using implant is an effective alternative for patients with early breast carcinoma,it has advantages of enough operative and oncologic security and better esthetic assessment.