保留乳头乳晕复合体改良根治术的选择和比较

Surgical selection and comparison of nipple-areola complex sensation after nipple-sparing mastectomy

目的总结乳腺癌根治术中保留乳头乳晕复合体(NAC)的效果与体会。方法选择2018年3月至2021年3月在我院因乳腺癌进行外科手术治疗的女性患者,纳入标准:(1)原发性肿瘤位于乳晕外;(2)肿瘤距离乳晕边缘>2 cm,共有99例患者入组,包括45例实施保留NAC的改良乳癌根治术(NSM)(NAC保留组)和未保留NAC的手术44例(NAC未保留组)。观察NSM后的临床效果,比较NAC保留和未保留患者术后病理特征、并发症,观察术后NAC感觉恢复情况。结果术前检查:两组患者在年龄、NAC直径、乳头距离肿瘤、术前肿瘤分期、类型、肿瘤部位及多病灶例数间的差异没有统计学意义(P>0.05)。NAC保留组术后病理:35例(77.8%)浸润性癌,10例(22.2%)属于导管原位癌,中位肿瘤大小为2.4 cm(0.2~4.1 cm),5例发现腋窝淋巴结转移;NAC未保留组中,浸润性癌37例(84.1%),7例(15.9%)原位癌,中位肿瘤大小为2.6 cm(0.2~4.7)cm,7例腋窝淋巴结转移。两组各有12例发生脂肪液化和血清肿,各有2例切口轻度感染,经保守治疗愈合。NAC保留组有8例乳头或乳晕坏死,其中7例为小部分坏死,经保守治疗愈合,1例坏死面积大行NAC切除。另NAC保留组和未保留组分别有3例和5例皮瓣坏死,均通过保守处理愈合。NAC保留患者中有3例(7.3%)乳晕感觉完全恢复,18例(43.9%)部分恢复,20例无感觉,乳头感觉恢复最差,仅1例患者术后乳头感觉敏感。两组患者术后满意度接近。结论保留NAC的改良乳癌根治术可行,美容效果良好,但只有较少部分NAC感觉恢复。

Objective To summarize the effect and experience of preserving nipple-areola complex(NAC)in radical mastectomy for breast cancer.Methods Female patients who underwent surgical treatment for breast cancer in our hospital from March 2018 to March 2021 were selected.The inclusion criteria included that the primary tumor was located outside the areola and the tumor was more than 2 cm away from the areolar edge.A total of 99 patients were enrolled,including 45 patients who underwent nipple-sparing mastectomy(NSM)(NSM group)and 44 patients who underwent standard mastectomy(standard group).The clinical effects including the sensory recovery of NAC after operation were observed after NSM.The postoperative pathological characteristics and complications between the patients with and without preservation of NAC were compared.Results Preoperative examination:there was no significant difference between the two groups in age,NAC diameter,nipple distance from tumor,preoperative tumor stage,type,tumor location and number of multiple lesions(P>0.05).Postoperative pathology in NSM group:35 cases(77.8%)were invasive carcinoma,10 cases(22.2%)were ductal carcinoma in situ,the median tumor size was 2.4 cm(0.2~4.1 cm),and axillary lymph node metastasis was found in 5 cases;In standard group,37 cases(84.1%)were invasive carcinoma,7 cases(15.9%)were carcinoma in situ,the median tumor size was 2.6 cm(0.2~4.7)cm,and 7 cases were axillary lymph node metastasis.There were 12 cases of fat liquefaction and seroma in each group,and 2 cases of slight wound infection in each group,which healed after conservative treatment.There were 8 cases of nipple or areolar necrosis in the NAC preservation group,of which 7 cases were small part necrosishealed after conservative treatment,and one case required NAC excision due to nipple necrosis.In addition,there were 3 cases and 5 cases of flap necrosis in NSM group and standard group respectively,all of which were healed by conservative treatment.Among the patients with NSM,3(7.3%)had complete areola sensation recovery,18(43.9%)had partial recovery,20 had no sensation,and the nipple sensation recovery was the worst.Only one patient had postoperative nipple sensation sensitivity.The postoperative satisfaction of the two groups was similar.Conclusion Nipple-sparing mastectomy is feasible and has good cosmetic effect,but nipple sensitivity following NSM was markedly diminished.