经腋窝切口腔镜下乳房皮下腺体切除联合即刻乳房重建的疗效观察  

Effectiveness of endoscopic nipple-sparing mastectomy combined with immediate breast reconstruction via axillary incision

作　　者：黄贞强[1,2] 陈凯 朱李玲[2] 曾剑锋[1] 周志平[1] 李顺荣[2] HUANG Zhenqiang;CHEN Kai;ZHU Liling;ZENG Jianfeng;ZHOU Zhiping;LI Shunrong(Department of General Surgery,the Second Affiliated Hospital of Fujian Medical University,Quanzhou Fujian,362000,P.R.China;Breast Tumor Center,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou Guangdong,510120,P.R.China)

机构地区：[1]福建医科大学附属第二医院普外科,福建泉州362000 [2]中山大学孙逸仙纪念医院乳腺肿瘤医学部,广州510120

出　　处：《中国修复重建外科杂志》2018年第11期1458-1462,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的介绍一种采用自制单孔通道经腋窝切口于腔镜下行乳房皮下腺体切除术(nipple-sparing mastectomy,NSM)联合即刻乳房重建的手术方法。方法 2017年1月—2018年2月,收治15例乳腺癌女性患者,采用自制单孔通道经腋窝切口于腔镜下行NSM联合即刻乳房重建。患者年龄27～45岁,平均37.5岁。乳腺癌分期Ⅰ期5例、Ⅱ期10例。病程1～24个月,平均8个月。肿瘤位于左侧8例、右侧7例。肿瘤直径1.5～3.0 cm,平均2.6 cm;肿瘤距离乳头1.8～4.0 cm,平均2.3 cm。结果术后出现乳头表层皮肤坏死1例,皮下积液1例;均未出现皮下气肿、皮瓣坏死。1例术后病理检查提示乳头后方组织阳性,行乳头切除。患者均获随访,随访时间7～17个月,平均11个月。重建乳房外观采用Harris评价标准:获优4例、良10例、一般1例。随访期间未发现肿瘤复发或转移。结论采用自制单孔通道经腋窝切口于腔镜下行NSM联合即刻乳房重建安全可行,美容效果好,为乳腺癌治疗提供了一种新选择。Objective To introduce an surgical technique of endoscopic nipple-sparing mastectomy（NSM）combined with immediate breast reconstruction through simple single-port access that placed in axillary incision.Methods Between January 2017 and February 2018, 15 female patients with breast cancer（stageⅠ in 5 cases and stageⅡ in 10 cases） were treated with endoscopic NSM combined with immediate breast reconstruction through simple singleport access that placed in axillary incision. They were 27-45 years old（mean, 37.5 years）. The disease duration ranged from 1 to 24 months（mean, 8 months）. The tumor located at the left breast in 8 cases and at the right breast in 7 cases.The diameter of tumor ranged from 1.5 to 3.0 cm（mean, 2.6 cm）. The distance between tumor and nipple was 1.8-4.0 cm（mean, 2.3 cm）. Results After operation, the nipple epidermal necrosis occurred in 1 case, and subcutaneous effusion in1 case. No subcutaneous emphysema or skin flap necrosis occurred. Postoperative pathological examination showed that1 case was nipple involvement and was treated with nipple resection. All patients were followed up 7-17 months（mean,11 months）. According to the Harris assessment criteria for appearance of reconstructed breast, there were 4 cases of excellent, 10 cases of good, and 1 case of poor. No tumor recurrence or metastasis occurred during follow-up.Conclusion It is a safe and feasible method of endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision, and can obtain good cosmetic results. It is a new option to breast reconstruction.

关 键 词：乳腺癌 乳房皮下腺体切除术 腔镜 乳房重建 

分 类 号：R737.9[医药卫生—肿瘤]