早期乳腺癌经皮下乳腺切除假体乳房重建术后不同切口的效果比较

Incision selection for nipple-sparing mastectomy with implant-based breast reconstruction

目的:探讨保留乳头乳晕复合体经皮下腺体切除即刻假体乳房重建术不同切口的临床效果。方法:回顾性分析2013年6月至2020年12月在首都医科大学附属北京同仁医院乳腺中心完成保留乳头乳晕复合体腺体切除即刻乳房重建术的92例患者的临床资料。患者均为女性,年龄(42.0±7.5)岁(范围:27~64岁),原发肿瘤0期12例,Ⅰ期47例,Ⅱ期17例,Ⅲ期16例。按手术入路不同分为3组,环乳晕组23例、下皱襞组33例、乳房外侧组36例,采用单因素方差分析、χ^(2)检验或Fisher确切概率法及拓展法分别比较三组患者的一般资料、肿瘤学资料、手术方式和术后并发症。结果:环乳晕组、下皱襞组、乳房外侧组的手术时间[(180.7±54.0)min比(176.9±48.1)min比(194.6±37.5)min,F=1.401,P=0.252],术后引流量[(497.5±226.0)ml比(495.4±182.5)ml比(519.8±172.0)ml,F=0.167,P=0.846]和引流天数[(8.8±3.8)d比(8.0±2.5)d比(8.3+2.9)d,F=0.542,P=0.583]差异均无统计学意义。环乳晕切口组总并发症发生率高于其他两组[26.1%(6/23)比0比8.3%(3/36),χ^(2)=9.675,P=0.004]。随访(49.0±25.6)个月(范围:12~112个月),乳腺癌相关病死率2.2%(2/92),局部复发率1.1%(1/92),区域复发率4.3%(4/92),远处转移率6.5%(6/92),无病生存率88.0%(81/92)。结论:经皮下乳腺切除假体乳房重建术中采用环乳晕切口、下皱襞切口、乳房外侧的手术效果相似,环乳晕切口的总体并发症发生率略高。

Objective To examine the outcome of different incision selection for nipple-sparing mastectomy(NSM)with implant-based breast reconstruction(IBBR).Methods Ninety-Two cases accepted NSM and IBBR from totally 1002 cases of breast cancer admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were analyzed retrospectively.All the patients were female,aging(42.0±7.5)years(range:27 to 64 years).There were 12 patients at stage 0,47 patients at stageⅠ,17 patients at stageⅡ,and 16 patients at stageⅢ.The patients were divided in three groups by the incision:peri-areolar group(n=23),inframammary group(n=33)and lateral group(n=36).The age,tumor size,lymph node status,hormone receptor,operation method and postoperative complications were followed-up of three groups and compared by one-way ANOVA,χ^(2) test or Fisher′s exact test and expansion to comparied.Results There was no significant difference in operation time((180.7±54.0)minutes vs.(176.9±48.1)minutes vs.(194.6±37.5)minutes,F=1.401,P=0.252),postoperative drainage volume((497.5±226.0)ml vs.(495.4±182.5)ml vs.(519.8±172.0)ml,F=0.167,P=0.846)and drainage time((8.8±3.8)days vs.(8.0±2.5)days vs.(8.3±2.9)days,F=0.542,P=0.583)among the peri-areolar,inframammary,and lateral groups.The cumulative postoperative complications were relatively higher in the peri-areola group(26.1%(6/23)vs.0 vs.8.3%(3/36),χ^(²)=9.675,P=0.004).All female patients were followed up for(49.0±25.6)months(range:12 to 112 months).Breast cancer related death rate was 2.2%(2/92),local recurrence was 1.1%(1/92),regional recurrence was 4.3%(4/92),distant metastasis was 6.5%(6/92),and the disease-free survival rate was 88.0%(81/92).Conclusion The surgical effects of the peri-areolar,inframammary and lateral incisions for NSM and IBBR are approximate,the total complication rate of the peri-areolar incision is slightly higher.