保留乳头乳晕复合体乳腺癌术后脱细胞异体真皮辅助乳房再造的效果评价

Immediate breast reconstruction with acellular cadaveric dermis after nipple-areola complex–sparing mastectomy for breast cancer

目的对比保留乳头乳晕复合体乳腺癌术后即刻乳房再造术与脱细胞异体真皮辅助乳房再造术的近期疗效、不良反应及美容效果。方法前瞻性纳入2015年1月至2017年11月新疆医科大学附属肿瘤医院收治的需行乳房重建的乳腺癌患者59例,随机分为两组,其中保留乳头乳晕复合体乳腺癌术后即刻假体重建(对照组)28例,脱细胞异体真皮辅助的保留乳头乳晕复合体乳腺癌术后即刻假体重建(辅助组)31例,对比两组间的治疗效果、并发症及美容效果。结果所有患者成功完成乳房重建。对照组皮瓣坏死的发生率为21.4%(6/28),辅助组25.8%(8/31),两组间差异无统计学意义(χ2=0.156,P=0.693)。所有患者于术后6个月对乳房重建美容效果进行评价,辅助组优良率为86.7%(26/30),显著高于对照组的63.0%(17/27),差异有统计学意义(Z=-2.287,P=0.022)。术后对照组术区积液的发生率为28.6%(8/28),辅助组32.3%(10/31),差异无统计学意义(χ2=0.094,P=0.759);未出现过敏、排斥反应等其他并发症和不良反应。随访无患者发生肿瘤复发及转移。结论保留乳头乳晕复合体乳腺癌术后采用即刻乳房再造术与脱细胞异体真皮辅助乳房再造术假体重建方式效果相当,术后并发症方面没有明显差异,脱细胞异体真皮辅助乳房再造的美容效果相对较好。

Objective To compare the short-term curative effect, complications and cosmetic result between immediate breast reconstruction and acellular cadaveric dermis-assisted immediate breast reconstruction after nipple-areola complex（NAC）？sparing mastectomy for breast cancer. Methods Between January 2015 and November 2017, a total of fifity-nine patients with breast cancer undergoing breast reconstruction in the Department of Breast Surgery, Affiliated Cancer Hospital, Xinjiang Medical University were included prospectively. Patients were randomly divided into two groups, 28 in the immediate breast reconstruction group（control group） and 31 in the acellular cadaveric dermis-assisted immediate breast reconstruction group（assisted group）. The short-term curative effect, complications and cosmetic result between two groups were studied. Results All patients successfully completed the breast reconstruction. The incidence rate of skin flap necrosis of the control group was 21.4%（6/28）, the assisted group 25.8%（8/31）; there was no statistically significant difference between the two groups（χ2=0.156, P=0.693）. All patients were evaluated the surgical results six months after the operation. The satisfaction rate of control group was 63.0%（17/27） and the assisted group was 86.7%（26/30）, with statistically significant difference（Z=-2.287, P=0.022）. The incidence of seroma in the control group was28.6%（8/28）, and the assisted group 32.3%（10/31）, with no statistically significant difference between the two groups（χ2=0.094, P=0.759）. Other complications such as allergies and rejection did not occur. Conclusion Therapeutic effect and complications are similar between the two reconstruction methods without postoperation complication differences, but the cosmetic result of acellular cadaveric dermis-assisted immediate breast reconstruction group is better.