部分游离胸大肌肌束填充乳头技术在保留乳头乳晕的乳房切除术中的应用  

The Application of Partial Free Pectoralis Major Muscle Bundle to Fill the Nipple in the Nipple Sparing Mastectomy

作　　者：潘宝军 孙政[3] 李国楼[3] 牛兆河[4] 王海波[4] 刘波 PAN Bao-jun;SUN Zheng;LI Guo-lou;NIU Zhao-he;WANG Hai-bo;LIU Bo(Qingdao University,Qingdao 266071,Shandong,China;Department of Thyroid and Breast Surgery,Changle People's Hospital,Weifang 262499,Shandong,China;Department of Thyroid and Breast Surgery,Weifang Hospital of Traditional Chinese Medicine,Weifang 261000,Shandong,China;Breast Disease Diagnosis and Treatment Center,Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong,China;Department of General Surgery,Xincheng Branch,Zaozhuang Municipal Hospital,Zaozhuang 277000,Shandong,China)

机构地区：[1]青岛大学,山东青岛266071 [2]昌乐县人民医院乳腺甲状腺外科,山东潍坊262499 [3]潍坊市中医院乳腺甲状腺外科,山东潍坊261000 [4]青岛大学附属医院乳腺病诊疗中心,山东青岛266003 [5]枣庄市立医院新城分院普外科,山东枣庄277000

出　　处：《中国美容医学》2020年第9期71-74,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨部分游离胸大肌肌束填充乳头技术在保留乳头乳晕的乳房切除术后维持乳头外观的应用价值。方法:回顾性收集2016年7月-2017年7月于潍坊市中医院行保留乳头乳晕的乳房切除术(Nipple sparing mastectomy,NSM)36例患者的病例资料,其中13例患者(实验组)使用部分游离胸大肌肌束填充乳头技术,对照组23例患者接受了传统NSM。对比两组术后1年乳头突度维持率及乳头宽度维持率;采用Harris评估标准评估术后两组患者乳房美容效果;通过随访复发转移及不良事件发生情况比较手术安全性。结果:术后1年与术后即刻相比,实验组、对照组突度维持率分别为(91.75±2.12)%、(81.73±6.12)%;宽度维持率分别为(93.63±3.47)%、(90.12±4.41)%,实验组均显著大于对照组,差异有统计学意义(均P<0.001)。术后乳房美容评价:实验组患者优良率为92.31%(12/13),对照组优良率为43.48%(10/23),组间比较差异有统计学意义(P<0.05)。实验组无复发转移,无乳头乳晕坏死,不良事件发生率15.38%(2/13);对照组无局部复发,远处(肝脏)转移1例,复发转移率4.35%(1/23),不良事件发生率13.04%(3/23);两组患者术后复发转移率及不良事件发生率比较差异均无统计学意义(P>0.05)。结论:对于NSM患者,部分游离胸大肌肌束填充乳头技术可以简单有效维持乳头体积。Objective To observe the clinical value of partial free pectoralis major muscle bundle to fill the nipple in the Nipple Sparing Mastectomy.Methods A total of 36 cases of breast cancer were retrospectively reviewed in theWeifang Hospital of Traditional Chinese Medicine from July 2016 to July 2017.Of these patients,13 cases underwent partial free pectoralis major muscle bundle to fill the nipple in the Nipple Sparing Mastectomy(the observation group),and the other 23 cases underwent Nipple Sparing Mastectomy(the control group).The projection and width of the nipple were measured at the time of surgery and at 1 year post surgery,respectively.The results of breast cosmetology were evaluated by Harris evaluation standard,and the safety of operation was compared by follow-up of recurrence,metastasis and adverse events.Results The mean maintenance of nipple projection values was(91.75±2.12)%and(81.73±6.12)%in the observation group and the control group,respectively,the difference was statistically significant(P<0.001).The mean maintenance of nipple widths was(93.63±3.47)%and(90.12±4.41)%in the observation group and the control group,respectively(P<0.001).The excellent and good rate was 92.31%(12/13)in the observation group and 43.48%(10/23)in the control group(P<0.05).In the observation group,there was no recurrence and metastasis,no nipple areola necrosis,the incidence of adverse events was 15.38%(2/13).In the control group,there was no local recurrence,distant(liver)metastasis was found in 1 case,the recurrence and metastasis rate was 4.35%(1/23),and the incidence of adverse events was 13.04%(3/23).There was no significant difference in the recurrence and metastasis rate and the incidence of adverse events between the two groups(P>0.05).Conclusion The partial free pectoralis major muscle bundle to fill the nipple is a useful and easy method to expand and augment the volume of nipples in Nipple Sparing Mastectomy.

关 键 词：乳头乳晕复合体 乳房切除术 乳腺癌 乳房重建 乳头 

分 类 号：R737.9[医药卫生—肿瘤]