即刻自体脂肪移植在乳腺癌切除保乳重建术中应用价值

Application of immediate autologous fat grafting reconstruction in breast-conserving surgery

目的评估乳腺癌切除保乳手术即刻进行自体脂肪移植重建患者的预后。方法 120例乳腺癌切除保乳手术治疗患者,单纯行乳腺癌切除保乳术者55例为保乳组,行乳腺癌切除保乳术即刻进行自体脂肪移植重建者65例为重建组;观察2组手术情况、术后乳房外形和近期并发症发生率。随访观察2组局部、区域复发及远处转移情况。结果 2组手术过程均顺利,保乳组术后患侧乳房局部塌陷,双侧乳房不对称,重建组术后患侧乳腺外形与健侧比较无明显变化;重建组术后近期并发症发生率(4.62%)与保乳组(3.64%)比较差异无统计学意义(P>0.05)。术后随访3~85.2个月,中位随访时间40.8个月,保乳组发生肿瘤复发转移5例(9.09%),其中发生在同侧乳腺1例,同侧腋窝淋巴结2例,远处转移2例;重建组发生肿瘤复发转移7例(10.77%),其中发生在同侧乳腺2例,同侧腋窝淋巴结3例,远处转移2例;重建组局部复发率(3.08%)、区域复发率(4.62%)和远处转移发生率(3.08%)与保乳组(1.82%、3.64%、3.64%)比较差异无统计学意义(P>0.05)。结论乳腺癌切除保乳术即刻自体脂肪移植重建手术患者的预后与单纯乳腺癌切除的保乳手术相当,并有助于乳房外观的改善。

Objective To assess the prognosis of the patients undergoing immediate autologous fat grafting(AFG) reconstruction in breast-conserving surgery(BCS). Methods Totally 120 patients with breast cancer were divided into BCS group(n=55) and BCS + AFG group(n=65) according to different surgical methods. The operation process, postoperative breast appearance and short-term complication were observed, and the local and regional recurrence as well as distant metastasis were followed up in two groups. Results Both groups completed the operation smoothly. The operated breast showed local collapse, and asymmetric with the other breast in BCS group, while the appearance of operated breast showed no obvious change in BCS+AFG group. The incidence of short-term complications showed no significant difference between BCS group(3.64%) and BCS+AFG group(4.62%)(P>0.05). All patients were followed up for 3 to 85.2 months, 40.8 months averagely, showing tumor recurrence and metastasis in 5 patients(9.09%) in BCS group including ipsilateral breast metastasis in 1, ipsilateral axillary lymph node metastasis in 2 and distant metastasis in 2, and tumor recurrence and metastasis in 7 patients(10.77%) in BCS+AFG group including ipsilateral breast metastasis in 2, ipsilateral axillary lymph node metastasis in 3, and distant metastasis in 2. The local recurrence rate, regional recurrence rate and distant metastasis rate showed no significant differences between BCS+AFG group(3.08%, 4.62%, 3.08%) and BCS group(1.81%, 3.64%, 3.64%)(P>0.05). Conclusion BCS plus AFG has similar prognosis with BCS, and can improve the appearance of the breast.