乳腺癌皮下腺体切除联合一期植入物乳房重建59例临床分析

Clinical analysis of 59 breast cancer patients undergoing mastectomy combined with primary implant breast reconstruction

目的探讨不同乳腺癌皮下腺体切除联合一期植入物乳房重建手术方法的安全性和美容效果。方法回顾性分析2008年1月至2016年12月在解放军总医院第一医学中心接受皮下腺体切除联合一期植入物乳房重建的59例乳腺癌患者临床资料。59例患者采取2种分组方式:(1)根据乳房切除方式不同,分为保留乳房皮肤的皮下腺体切除术(SSM)与保留乳头、乳晕复合体的皮下腺体切除术(NSM)2组;(2)根据乳房重建方式不同,分为“一步法”或“两步法”2组。采用秩和检验或Fisher确切概率法分别比较2组乳房切除方式和2组重建方式的并发症和美容效果。采用Kaplan-Meier法进行患者生存分析。结果33.9%(20/59)患者行SSM,66.1%(39/59)患者行NSM;44.1%(26/59)患者行“一步法”重建,55.9%(33/59)患者行“两步法”重建。30.5%(18/59)患者同时行对侧乳腺预防性皮下腺体切除术加植入物重建术。中位随访71个月(范围:27~133个月),失访12例。随访的47例患者中术后假体移位发生率为10.6%(5/47),包膜挛缩和假体破裂发生率均为4.3%(2/47)。21.3%(10/47)患者最终取出植入物。不同乳房切除方式的并发症发生率和植入物取出率差异无统计学意义(P=0.697、0.716);不同重建方式的并发症发生率和植入物取出率差异无统计学意义(P=0.449、1.000)。死亡2例,余45例患者术后美容效果评分的优良率为73.3%(33/45),不同乳房切除方式和不同重建方式的术后美容效果评分比较差异无统计学意义(P=0.296、1.000)。患者是否同时行对侧预防性皮下腺体切除及植入物重建术的美容效果评分比较差异也无统计学意义(P=0.571)。患者的OS率为95.7%(45/47),DFS率为89.4%(42/47)。结论乳腺癌皮下腺体切除联合一期植入物乳房重建术后总体生存情况良好,不管采用哪种乳房切除方式或重建方式,术后不良事件与并发症发生率均较低,可达到预期的临床疗效,并获得良好的美容效果。

Objective To investigate the safety and cosmetic effect of mastectomy combined with primary implant breast reconstruction for breast cancer patients.Methods The clinical data of 59 breast cancer patients who underwent mastectomy combined with primary implant breast reconstruction in the General Hospital of PLA from Janurary 2008 to December 2016 were retrospectively analyzed.All patients were divided into two groups:skin-sparing mastectomy(SSM)group and nipple-sparing mastectomy(NSM)group(sparing the nipple-areola complex)or according to the different methods of breast reconstruction,they were divided into one-step reconstruction group and two-step reconstruction group.The rank sum test or Fisher exact test was used to compare the complications and cosmetic effect between SSM group and NSM group,or between one-step reconstruction group and two-step reconstruction group.The Kaplan-Meier method was used for survival analysis.Results In all cases,33.9%(20/59)of the patients underwent SSM and 66.1%(39/59)underwent NSM;44.1%(26/59)underwent one-step breast reconstruction and 55.9%(33/59)underwent two-step breast reconstruction.Totally 30.5%(18/59)of cases underwent contralateral prophylactic mastectomy plus implant reconstruction at the same time.The median follow-up was 71 months(range:27-133 months),and 12 cases were missing in the follow-up.The incidence of postoperative prosthesis displacement was 10.6%(5/47),and the incidence of capsular contracture and prosthesis rupture were both 4.3%(2/47).The implants were removed in 21.3%of the patients(10/47).The complication rate and incidence of implant removal presented no significant difference between SSM group and NSM group(P=0.697,0.716),or between one-step reconstruction group and two-step reconstruction(P=0.449,1.000).The proportion of patients with excellent and good cosmetic scores was 73.3%(33/45),indicating no significant difference between SSM group and NSM group,or between one-step reconstruction group and two-step reconstruction(P=0.296,1.000).There was no significant difference in the cosmetic scores between patients with contralateral prophylactic mastectomy plus implant reconstruction and patients without(P=0.571).The OS of all patients was 95.7%(45/47),and the DFS was 89.4%(42/47).Conclusion The mastectomy combined with primary implant breast reconstruction yeilds excellent overall survival,low incidences of adverse events or complications and good cosmetic effect in breast cancer patients whether they receive SSM or NSM,one-step or two-step breast reconstruction.