无充气腔镜辅助小切口保留乳头乳晕乳腺癌根治术+无补片Ⅰ期假体乳房重建的创新与实践

Innovation and practice of endoscope-assisted nipple-sparing mastectomy combined with immediate subpectoral implant breast reconstruction without gas and mesh through small skin incisions

目的探讨无充气腔镜辅助小切口保留乳头乳晕乳腺癌根治术+无补片Ⅰ期假体乳房重建的手术方法的可行性。方法回顾性分析2021年6至11月中国科学技术大学附属第一医院收治的7例无充气腔镜辅助小切口保留乳头乳晕乳腺癌根治术+无补片Ⅰ期胸肌后假体乳房重建患者的临床数据,平均年龄44.9,范围为(29~63)岁。收集患者临床分期、术后并发症等资料,要求患者在术前和术后随访期间匿名填写BREAST-Q量表,并进行统计学分析,P<0.05为差异有统计学意义。结果均为单发病灶,平均直径1.74 cm,范围为(0~5)cm;病灶距乳头平均距离2.11 cm,范围为(0~4)cm。术后病理临床分期:Tis 1例,Ⅰ期3例,II期2例,ypT0pN0cM0 CR 1例。平均手术时间245.3 min,范围为(195~316)min,术中平均出血量37.1 ml,术后平均住院天数5.1 d,中位随访时间为8.8个月,平均(6~11.2)个月。7例患者切口均为Ⅰ期愈合,均未出现感染、切口并发症、包膜挛缩、皮瓣坏死、NAC乳头乳晕坏死、假体取出、假体移位等不良并发症。随访期间未发现癌症复发或转移。与术前相比,术后患者的胸部功能满意度及社会心理健康评分降低,差异有统计学意义(P<0.05),但仍处于较理想状态;而乳房外形满意度及性生活满意度评分与术前基线差异无统计学意义(P>0.05)。结论无充气腔镜辅助小切口保留乳头乳晕乳腺癌根治术+无补片Ⅰ期假体乳房重建术安全可行,美容效果佳,可作为一种新的乳房重建术式推广。

Objective To examine the feasibility and safety of endoscopic subcutaneous mastectomy and immediate reconstruction via a small skin incision approach without gas and mesh for early breast carcinomas.Methods We analyzed 7 patients diagnosed with breast cancer who underwent an endoscopic subcutaneous mastectomy and immediate reconstruction from Jun.to Nov.2021 using a gasless and meshless small skin incision approach at the Department of Thyroid and Breast Surgery,the First Affiliated Hospital of USTC.Mean age was 44.9(29-63)years.Clinical stage,postoperative complications and other data of patients were collected.Patients were required to fill in BREAST-Q scale anonymously before and during postoperative follow-up.The difference was considered significant for P<0.05.Results The tumors were all unilateral and solitary lesions,with a mean diameter of 1.74(0-5)cm.The average distance of mass from the nipple on imaging was 2.11cm(range 0 to 4).Postoperative pathological clinical stage,1 patient was in Tis,3 patients were in stage I,2 patients were in stage II and a pathological complete response was achieved in one patient(ypT0pN0cM0 CR).The mean operative time was 245.3(195-316)min,the mean intraoperative bleeding volume was 37.1ml,the mean postoperative hospital stay was 5.1 d,and the median follow-up time was 8.8(6-11.2)months.All the 7 patients had incision healing at the first stage,and no complications such as infection,incision complications,capsular contracture,nipple-areola complex or skin flap necrosis,removal or displacement of breast implant occurred.No local recurrence or metastasis was detected during the follow-up period.Compared with preoperative,the scores of postoperative psychosocial status,chest wall status were lower(P<0.05),but still ideal,while breast satisfaction and sexual satisfaction scores were not significantly different from preoperative baseline(P>0.05).Conclusion This study indicates that endoscope-assisted breast reconstruction with gasless and meshless is a safe and feasible surgical intervention method for early breast cancer,with good cosmetic effects,and can be promoted as a new type of breast reconstruction.