达芬奇机器人在乳腺癌根治切除并一期假体重建中的临床应用

Practice of da Vinci robotic surgical system in mastectomy and immediate one-stage implant-based breast reconstruction

目的 探讨达芬奇机器人在乳腺癌根治及一期假体重建中的临床应用。方法 回顾性分析2022年3月至2022年4月期间于空军军医大学第一附属医院甲乳血管外科接受保留乳头乳晕的皮下腺体切除并一期假体重建的5例乳腺癌患者的临床资料,包括操作要点、手术时间、术后并发症及患者报告结局情况。结果 5例患者中,2例接受了胸肌后无补片的假体重建,其中1例同时接受了机器人下甲状腺癌根治术;3例接受胸肌前联合生物补片的假体重建,其中2例患者接受了双侧乳房重建手术。5例患者的手术时间为240~320 min,平均291 min;术中出血10~30 mL,平均18 mL,未出现术中出血导致腔镜手术被迫转为开放手术的情况;术后前3天平均引流量约为78 mL/d(60~100 mL/d),术后3~7 d平均引流量为38 mL/d(30~50 mL/d);引流管拔除时间为术后10~18 d,平均13.2 d;平均手术费用为45 072元(43 420~47 524元);术后无感染及乳头乳晕复合体缺血坏死发生;住院时间1~3 d,平均1.8 d。术后1个月乳房满意度评分为64~82分,平均为76.20分。结论 机器人辅助下进行乳腺癌根治及一期假体重建具有更好的显露空间,术后无特殊并发症,患者满意度较高,安全可行,但手术时间较长,费用昂贵,在手术选择时仍需个性化对待。

Objective To investigate the clinical application of da Vinci surgical system in nipple sparing mastectomy(NSM) and immediate one-stage implant-based breast reconstruction. Methods Five cases of breast cancer who underwent NSM and immediate implant-based breast reconstruction were analyzed from March 2022 to April 2022.Evaluation endpoints included the key points of operation, duration of surgery, postoperative complications, and patientreported outcomes. Results Two patients underwent implant-based postpectoral breast reconstruction without mesh.Three patients received prepectoral reconstruction with biological mesh, 2 of which underwent bilateral breast reconstruction. Operating duration of 5 patients was 240–320 min, with an average of 291 min. The blood loss was10–30 mL, with an average of 18 mL. No patient switched to open surgery due to the uncontrolled bleeding. The average drainage volume was 78 mL/d(60–100 mL/d) in the first 3 days and 38 mL/d(30–50 mL/d) in the 3 to 7 days after operation. The drainage tube was removed 10–18 days after operation, with an average of 13.2 days. No postoperative infections or nipple-areolar complex necrosis were observed. The inpatient stay was 1–3 days, with an average of 1.8 days. One month after operation, the BREAST-Q satisfaction score was 64–82, with an average of 76.20.The average cost for operation was 45 072 RMB(43 420–47 524 RMB). Conclusions The robotic NSM and immediate one-stage implant-based breast reconstruction is a safe procedure with better clinical outcomes and favorable patients’ satisfaction. However, the robotic system has longer operation time and higher cost. It still needs to be personalized in the clinical practice.