单孔充气法腔镜乳房皮下腺体切除术联合一期假体植入乳房重建术临床分析

Clinical application of single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation

目的探讨单孔充气法腔镜乳房皮下腺体切除术联合一期假体植入乳房重建术在早期乳腺癌治疗中的临床应用价值。方法回顾性分析2014年2月至2019年7月于首都医科大学附属北京友谊医院接受单孔充气法腔镜乳房皮下腺体切除术联合假体植入乳房重建手术的34例早期乳腺癌患者的临床病理学资料。患者均为女性,年龄46(11)岁[M(QR)](范围:26~64岁)。对手术根治性、术后美容效果进行评估,并采用乳腺患者报告结局量表评价患者的生活质量和满意度。结果 34例患者手术均顺利完成,手术时间(313.4±11.7)min(范围:200~485 min),术中出血量(33.8±3.3)ml(范围:10~100 ml)。5例患者术后发生乳头乳晕缺血坏死,其中1例因乳头乳晕坏死导致假体外露最终手术取出假体;无包膜挛缩、术后出血等并发症。术后随访时间为35(17)个月(范围:12~77个月),1例发生局部复发伴远处转移,1例发生远处转移。患者术后乳房满意度、社会心理状态、胸壁状态、性健康程度评分分别为(78.3±2.6)分(范围:55~100分)、(89.1±2.3)分(范围:82~100分)、(91.47±1.33)分(范围:43~100分)、(78.5±2.7)分(范围:39~100分)。结论单孔充气法腔镜乳房皮下腺体切除术联合一期假体植入乳房重建术可获得较好的根治效果和美容效果,患者术后生活质量和满意度较高。

Objective To examine the clinical application value of single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation in the treatment of early breast cancer.Methods From February 2014 to July 2019,the clinic-pathological data of 34 early breast cancer patients received single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation at Department of General Surgery,Beijing Friendship Hospital,Capital Medical University were retrospectively analyzed and followed up.All the patients were female,with an age of 46(11)years(M(Q_(R)))(range:26 to 64 years).The radical cure degree of operation,cosmetic effect after operation were evaluated.The satisfaction to operation and personal quality of life after operation was accessed by BREAST-Q scale.Results All surgical procedures were successfully completed.The operation time was(313.4±11.7)minutes(range:200 to 485 minutes).The blooding-liquid was(33.8±3.3)ml(range:10 to 100 ml).There were 5 cases(14.7%)of nipple areola necrosis after operation,of which 1 patient received taking the prosthesis out because of prosthesis exposure.There was no capsular contracture or postoperative bleeding case.The follow-up time was 35(17)months(range:12 to 77 months),and there was one case suffering local recurrence and metastasis,and another suffering metastasis.The scores of postoperative breast satisfaction,psychosocial status,chest wall status and sexual health were 78.32±2.57(range:55 to 100),89.12±2.30(range:82 to 100),91.47±1.33(range:43 to 100),and 78.50±2.68(range:39 to 100).Conclusion Single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation in the treatment of early breast cancer can achieve provided curative and cosmetic effect on patients with breast cancer,with good patients′postoperative quality of life and satisfaction.