腔镜辅助保留乳头乳晕乳腺癌手术Ⅰ期假体乳房重建的探讨

Discussion of Immediate Breast Construction with Prosthesis after Endoscopic-assisted Nipple-sparing Mastectomy

目的：探讨腔镜辅助下保留乳头乳晕乳腺癌改良根治术Ⅰ期乳房重建的方法和疗效。方法：对28例Ⅰ、Ⅱ期乳腺癌患者行腔镜下腋窝淋巴结清扫保留乳头乳晕乳腺癌改良根治术,辅助腔镜下一期假体或扩张器植入乳房重建,Ⅱ期扩张器取出假体植入乳房重建。结果：28例中,7例一期植入硅凝胶假体,体积220~325ml。1例乳房体积小于对侧,化疗结束后3个月,更换较大假体。乳腺癌发病率逐年增高,且年轻化,严重威胁着女性生命,切除乳腺也给患者的形体和心理留下巨大创伤。腔镜技术在乳腺外科的应用使部分乳腺癌在治愈疾病的同时获得最佳的美容效果[1]。本科室自2008年6月至2012年6月行行腔镜辅助下保留乳头乳腺癌改良根治术一期乳房重建28例,取得了良好的效果,现报告如下。21例放置扩张器并注水380-500ml,其中3月后2例破裂,再次更换;1例放疗后皮肤破溃,假体外露,取出扩张器,未再更换。20例中放入扩张器6-15月后,化疗结束3月,放疗结束6月,全部更换为解剖型乳房假体;其中13例行健侧乳房上提缩小术,使两侧乳房对称。术后随访12-52个月,中位平均随访时间为32个月,全组无局部复发和远处转移。无包膜挛缩,乳房形态良好,美容效果满意。结论：腔镜辅助下保留乳头乳腺癌改良根治术假体或扩张器一期植入乳房重建,Ⅱ期扩张器取出更换解剖型假体,健侧乳房上提,可作为早期乳腺癌美容效果较好的一种手术治疗方法。

Objective：Discuss the me thod and efficacy of immediate breast construction with prosthesis after endoscopic-assisted nipple-sparing mastectomy. Methods： 28 stage-Ⅰ、 Ⅱ breast cancer patients had received nipple-sparing mastectomy with endoscopic axillary lymph node, immediately received prosthesis or tissue expander implanting surgery to reconstruct breast, replace the expander by the prosthesis in stage -two surgery. Results：In the 28 cases,7 cases received silicone breast implantation,the volume is 220-325ml, 1 cases replaced a larger prosthesis, after the end of chemotherapy 3 months,because of the asymmetric breasts. 21cases received tissue expander implantation, and inject 380-500ml saline. Among the 21 cases,2 patients replaced new expander because of the expander rupture; 1 remove the expander without other replacement, because the skin ulceration and the exposure of prosthesis after the radiotherapy. 20 cases,after the tissue expander implantation 6-15months, after the chemotherapy 3 months, after the radiotherapy 6 months, totally replaced the expander by the prosthesis,among the 20 cases, 13 cases received vertical lifting and reduction mammaplasty to the contralateral breast in order to achieve the symmetry of breasts. Patients were followed up 12-52 months（median 36 months） after operation, no local recurrence and distant metastasis. No capsular contracture, all cases got good breast shapes and satisfied with the cosmetic effect. Conclusion：Iimmediate breast construction with prosthesis after endoscopic-assisted nipple-sparing mastectomy,replace the expander by the prosthesis in stage -two surgery,with vertical lifting the contralateral breast,can be considered to be a effective cosmetic operation method to early stage breast cancer.