乳头乳晕复合体的局部解剖与保留

Anatomy and preservation of the nipple-areola complex

在保乳手术与保留乳头乳晕复合体(NAC)的乳房切除术(NSM)中保留NAC,在病例选择合适的前提下,可以获得良好的肿瘤安全性与乳房美学效果。但有关乳头及NAC的局部解剖与如何在选择病例实现个体化治疗与完成肿瘤安全切除的基础上,保留NAC并重塑乳头外形等方面,仍然有诸多疑惑。本文对乳头乳晕复合体、乳头内及乳头后方局部解剖进行了详细描述;对NSM术中乳头乳晕部手术操作、乳头内乳管束的处理、乳头后方乳管束的处理等结合经验与术中图片介绍了自己的经验;对保留NAC时的病理学评估、伴有乳头溢液的乳腺癌患者NAC的保留问题、NAC保留与放疗等进行了讨论。事实上,我国的现状是太多的患者可能适合保乳手术或NSM后即刻、延期即刻或二期重建。熟悉乳头及NAC的局部解剖特点,对规范开展乳腺癌保乳手术与NSM,使更多乳腺癌患者得以安全保留NAC与乳房,或者可以在保留NAC的基础上完成乳房重建都十分重要。

Preserving nipple-areola complex(NAC)in breast-conserving surgery and nipple-areola complex-sparing mastectomy(NSM)can achieve good tumor safety and breast aesthetics under the premise of appropriate case selection.However,there are still many doubts about the local anatomy of the nipple and NAC and how to preserve the NAC and reshape the shape of the nipple on the basis of selecting cases to achieve individualized treatment and complete tumor resection.In this paper,the NAC,internal nipple and posterior nipple anatomy are described in detail;Combined with the operation of NAC during NSM operation,the treatment of breast duct bundle inside the nipple and behind the nipple were introduced with author′s experience and pictures.The pathologic evaluation of preserving NAC,NAC conservation in breast cancer patients with nipple discharge and radiotherapy after NAC conservation were discussed.In fact,the current situation in our country is that too many patients may be suitable for immediate breast reconstruction or delayed breast reconstruction after NSM.It is very important to be familiar with the local anatomical characteristics of nipples and NAC for standardized breast conserving surgery and NSM.Therefore,more patients with breast cancer can safely retain NAC and breast,and breast reconstruction can be further accomplished on the basis of preserving NAC.