保留乳头乳晕复合体的全乳皮下切除术后乳头坏死原因分析及手术策略

Analysis of causes and surgical strategies of nipple necrosis after nipple sparing mastectomy

目的 研究保留乳头乳晕复合体的全乳切除术(NSM)后乳头坏死原因及外科处理策略.方法 选取我院收治的87例乳腺癌行NSM患者作为研究对象.收集所有研究相关临床资料,分析NSM术后乳头坏死原因、危险因素,探讨外科处理策略.结果 年龄、基础疾病史、吸烟史、术前辅助治疗史、乳房下垂程度、乳房体积、切口选择、重建类型及皮瓣厚度均与术后发生乳头坏死相关(P<0.05).多因素Logistic回归分析结果 显示,年龄、基础疾病史、术前辅助治疗史是术后发生乳头坏死的独立危险因素(P<0.05).结论 临床上应根据以上危险因素严格筛选合适病例及手术方式,以降低术后乳头坏死的风险.

Objective To study the causes and surgical strategies of nipple necrosis after nipple sparing mastectomy(NSM).Methods A total of 87 cases with breast cancer who underwent NSM admitted in our hospital were selected as the study objects.The study related clinical data was collected to analyze the causes and risk factors of nipple necrosis after NSM,and to explore surgical strategies.Results Age,history of underlying diseases,smoking history,history of preoperative adjuvant therapy,degree of breast prolapse,breast volume,incision selection,reconstruction type and skin flap thickness were all correlated with postoperative nipple necrosis(P<0.05).The results of multivariate Logistic analysis showed that age,history of underlying diseases and history of preoperative adjuvant therapy were independent risk factors for postoperative nipple necrosis(P<0.05).Conclusion In order to reduce the risk of postoperative nipple necrosis,proper cases and surgical methods should be strictly screened according to the above risk factors.