保留乳头乳晕乳房切除联合Ⅰ期扩张器植入术的并发症及处理  

Management of Complications of Nipple-areola Complex-sparing Mastectomy Combined With Immediate Breast Reconstruction With Expander Implantation

作　　者：王学晶[1] 姚儒[1] 张海林[2] 周易冬[1] 茅枫[1] 孙强[1] Wang Xuejing;Yao Ru;Zhang Hailin(Department of Breast Surgery,Chinese Academy of Medical Sciences Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院乳腺外科,北京100730 [2]中国医学科学院北京协和医院整形外科,北京100730

出　　处：《中国微创外科杂志》2018年第6期509-512,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市科技计划课题(D61100000816005);北京市适龄妇女乳腺癌筛查方案优化研究.

摘　　要：目的总结保留乳头乳晕乳房切除(nipple-areola complex-sparing mastectomy,NSM)联合Ⅰ期扩张器植入术的并发症处理经验。方法回顾性分析2014年1月~2017年2月我科22例NSM联合Ⅰ期扩张器植入术后发生并发症的临床资料。结果 12例乳头乳晕复合体(nipple-areola complex,NAC)血运障碍,包括单纯环乳晕切口9例,环乳晕边缘延长切口3例。单纯环乳晕切口1例NAC完全坏死,手术切除乳头乳晕,其余11例局部换药后好转。1例切口感染,经清创换药后愈合。1例皮下积液合并感染手术取出扩张器,经清创换药后好转。扩张器暴露1例,手术取出扩张器更换假体。扩张器上移7例,待Ⅱ期更换假体手术时调整位置。结论可以通过改进手术操作及术后管理减少NSM联合Ⅰ期扩张器植入术并发症的发生。Objective To analyze the management of complications of nipple-areola complex-sparing mastectomy （NSM） combined with immediate breast reconstruction with expander implantation. Methods From January 2014 to February 2017, 80 patients with breast cancer were treated with NSM combined with immediate breast reconstruction with expander implantation in our hospital. We retrospectively summarized complications and relative management of 22 patients. Results There were 12 patients suffering from blood circulation disorder in nipple-areola complex （NAC）, including 9 patients with simple surround areolar incision and 3 patients with surround areola plus nearby extended incision. One case underwent excision of nipple and areola after total necrosis of NAC. The other 11 cases relieved after local dressing changes. One patients suffered from wound infection and healed by debridement and dressing changes. One patient underwent removal of expander due to infection. One patient was treated by replacement of implant after exposure of expander. Expander displacement was found in 7 cases and was adjusted in the second stage surgery. Conclusion Improving surgical performance and post-operative management decreases the complications of NSM combined with immediate breast reconstruction with expander implantation.

关 键 词：乳腺癌 乳房重建 保留乳头乳晕乳房切除术 扩张器植入 并发症 

分 类 号：R737.9[医药卫生—肿瘤]