乳腔镜辅助乳腺癌腺体切除假体植入一期成形17例报告  

Mastoscopic Mastectomy and Immediate Breast Reconstruction with Implants for Breast Cancer: A Report of 17 Cases

作　　者：刘宝胤[1] 丁毅[1] 骆成玉[1] 郑姗姗[2] 

机构地区：[1]首都医科大学附属复兴医院普外科,北京100038 [2]首都医科大学附属复兴医院整形外科,北京100038

出　　处：《中国现代手术学杂志》2013年第2期104-107,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨在乳腔镜辅助下行皮下腺体切除、假体植入一期成形术治疗乳腺癌的手术方法、可行性及疗效。方法 2009年3月～2012年5月乳腺癌患者17例,均在乳腔镜辅助下行皮下腺体切除及腋窝淋巴结清扫,一期将假体植入胸大肌后方间隙。结果 17例乳腔镜辅助单侧乳腺腺体皮下切除、假体植入一期成形术均获成功。切除腺体组织切缘未见癌残留。按TNM分期:T1N0M0期5例,T1N1M0期1例,T2N0M0期9例,T2N1M0期2例。术后病理证实16例为浸润性导管癌,1例为小叶癌。腋窝淋巴结病理发现1例有1枚淋巴结阳性,2例3枚淋巴结阳性。17例均无皮下气肿、乳头及皮肤局部坏死情况。均在术后7～10 d拔除引流管,4例出现腋窝少量积液,穿刺抽吸加压包扎后好转,无其他并发症发生。17例均获随访,随访时间3～41个月,中位时间18个月,均无局部复发及远处转移,无患侧上肢水肿及功能障碍。术后外观评价:优9例,良6例,尚可1例;优良率达94.1%。结论乳腔镜辅助下行皮下腺体切除、假体植入一期成形术治疗乳腺癌,可减少手术创伤,安全可行,美容效果好。Objective To investigate the surgical skill, feasibility and cosmetic results of mastoscopic subcutaneous mastectomy and immediate breast reconstruction with implants. Method From March 2009 to May 2012, a total of 17 breast cancer cases received mastoscopic subcutaneous mastectomy and immediate mammaplasty with implants beneath the pectoraIis major in our hospital Results All of the 17 cases were performed mastoscopic subcutaneous mastectomy and immediate reconstruction with implants successfully. All cases underwent mastoscopic axillary lymph node dissection directly. No residual was found in frozen sections. According to TNM classification, 5 cases were T1NOM0, 1 case was TIN1M0, 9 cases were T2NOM0 and 2 cases were T2N1M0. Infiltrating duct carcinoma was confirmed in 16 cases and lobular carcinoma in 1 case by postopera- tive pathological exam. There was no subcutaneous emphysema, nipple necrosis or skin necrosis in all eases. Subcu- taneous hydrops was found in 4 cases after operation and cured by puncture, suction and press dressing. No other complications were found. All 17 patients were followed up for 3 to 41 months ~＇ithout metastasis or recurrence. No edema of the involved upper extremity and dysfunction occurred. The outcome revealed excellence in 9 eases, good in 6 cases, fair in 1 case, and the rate of satisfactory.cosmetic result was 94.1%. Conclusion Mastoseopic sub- cutaneous masteetomy and immediate reconstruction with implants can decrease operative trauma and is a safe and feasible procedure for breast cancer with good cosmetic result.

关 键 词：乳房成形术 乳房植入物 内窥镜检查 乳腺肿瘤 乳房切除术 区段 

分 类 号：R655.8[医药卫生—外科学] R737.9[医药卫生—临床医学]