保乳头乳晕全乳切除与标准改良根治术后即刻乳房重建的临床对照研究

Clinical controlled study of the nipple areola complex sparing mastectomy and modified radical mastectomy with immediate reconstruction in patients with breast cancer

目的 近年来随着乳腺癌的早期发现和治愈率不断提高,患者对自身形态的要求远远大于对疾病的恐惧。因此,如何选择更好的方法恢复患者身体形态是当前医生需考虑的首要问题。本研究比较保留乳头乳晕的全乳腺切除术＋即刻乳房重建（NSM＋IBR）与标准改良根治术＋即刻乳房重建（MRM＋IBR）的并发症、美容效果和疗效,探讨NSM＋IBR的临床应用价值。方法 选择山东省临沂市肿瘤医院乳腺科2006-12-01-2012-10-01收治的初诊为乳腺癌（0-Ⅱ期）患者共56例,其中NSM＋IBR组共32例,MRM＋IBR组共24例,所有患者均采用背阔肌肌皮瓣重建乳房,比较两组患者的手术后并发症、美容效果和局部复发、远处转移情况。结果 两组患者平均随访70.48个月,中位随访84个月,均未出现局部复发,NSM＋IBR组远处转移2例,MRM＋IBR组远处转移1例,两组远处转移发生率差异无统计学意义,P=0.608。MRM＋IBR组发生血清肿共7例,皮瓣缺血2例,切口感染1例,切口裂开1例;NSM＋IBR组发生血清肿共8例,乳头乳晕或皮瓣缺血共10例,切口感染1例,切口裂开2例;其中,皮瓣缺血发生率NSM＋IBR组高于MRM＋IBR组,差异有统计学意义（χ^2=8.727,P=0.003）,其余并发症两组间差异无统计学意义,均P〉0.05。美容效果评价,MRM＋IBR组优为5例,良为13例,一般为6例,差为0例;NSM＋IBR组优为25例,良为6例,一般为1例,差为0例;两组间美容效果差异有统计学意义,P=0.020。结论 NSM＋IBR具有安全有效、美容效果好等优点,为有乳房重建愿望的乳腺癌患者提供了更多选择。

OBJECTIVE As early diagnosis and increased cure rates in breast cancer in recent years, the patient＇s demand for their own form is much greater than the fear of disease. Therefore, it is the chief problem for doctors to consider how to choose the better way to restore patients＇ form. This study compared the complications, cosmetic outcomes, effects in nipple-areola complex（NAC）-sparing mastectomy and immediate breast reconstruction with modified radical mastectomy and immediate breast reconstruction to evaluate clinical application of the nipple-areola complex（NAC）-sparing mastectomy and immediate breast reconstruction （NSM＋IBR） in patients with breast cancer. METHODS We retro- spectively reviewed 56 cases of breast cancer in Department of Breast Surgery of Linyi Tumor Hospital between December lst,2006 and December 1st, 2012. Of these 56 patients, 32 cases with nipple-areola complex（NAC）-sparing mastectomy and immediate reconstruction and 24 cases with modified radical mastectomy and immediate reconstruction. All of these cases received latissimus dorsi myocutaneous flap reconstruction. The complications, cosmetic outcomes, local recur- rences and distant metastases were compared. RESULTS The mean and median time of follow-up were 70.48 months and 84 months, respectively. No local recurrence was found in both groups. Two cases had distant metastases in NSM＋ IBR group while 1 cases in MRM＋IBR group, but there was no significant difference （P〉0.05）. The rate of flap necro- sis was significantly higher in the NSM＋IBR group than that in the MRM＋IBR group （P=0. 003）. Other complications and total complications had no significant difference in both group. For NSM＋ IBR group, the cosmetic outcomes were significantly better than that of MRM＋IBR group （P=0.020）. CONCLUSIONS NSM＋IBR is technically feasible. It is safe, efficient and good cosmetic. It is one of the good choice for breast reconstruction.