腔镜辅助下乳晕区小切口皮下全乳腺体切除一期假体植入术

Video -assisted subcutaneous total mastectomy through small areola incision and one -stage reconstruction with breast prosthesis

目的探讨腔镜辅助下乳晕区小切口皮下全乳腺体切除一期假体植入乳房重建的方法和效果。方法15例患者中，浸润性乳腺癌7例，导管内癌2例，良性乳腺病6例。乳腺癌患者均先行肿瘤扩大切除，病理确诊后行腔镜辅助下皮下腺体切除一期假体植入，浸润性乳腺癌患者行腋窝淋巴结清扫。导管内癌患者及良性疾病在腔镜辅助下行乳晕区小切口皮下全乳腺体切除一期假体植入。结果15例患者3例出现切口皮瓣轻度坏死，延迟愈合；1例出现乳头感觉异常，色素沉着。2例外形不对称，效果欠佳，13例患者对外形满意。乳腺癌患者术后在随访期内均未出现局部复发或（和）远处转移。结论腔镜辅助下乳晕区小切口乳房皮下切除一期假体植入对需行全乳切除的患者是安全可行且美容效果较好的一种手术方法。

Objective To explore the method and efficacy of video - assisted subcutaneous total mastectomy through small areola incision and one - stage reconstruction with breast prosthesis. Method In 15 patients with breast diseases, there were 7 patients with invasive breast cancer , 2 patients with intraductal breast cancer , and 6 patients with benign breast disease. All the patients received extensive breast tumor ressection through small areola incision. After breast cancer was proven with histopathological examination during the operation, video - assisted subcutaneous total mastectomy was performed, followed by one - stage reconstruction with breast prosthesis. Axillary lymph node dissection was per- formed in patients with invasive breast cancer. Patients with intraductal breast cancer or benign breast disease only re- ceived video - assisted subcutaneous total mastectomy and one - stage breast reconstruction through small areola insision. Result Among the 15 cases, 3 cases suffered from mild skin flap necrosis around the incision with delayed healing, 1 case suffered from sensory abnormalities and pigmentation of the nipple, breast asymmetry occnred in 2 cases with poor orthopedic effect, and 13 cases were satisfied with their breast shape. During the follow -up period, all the 15 cases had no recurrence or remote metastasis. Conclusion Video - assisted subcutaneous total mastectomy through small areola incision and one - stage reconstruction with breast prosthesis is a safe and feasible procedure with good orthopedic effect for patients who receive total mastectomy.