"隐形自然腔隙"术式在乳腺癌一期假体乳房重建中的应用  

Clinical application of immediate breast reconstruction using the"latent orifice"procedure

作　　者：刘泰源 姜黎黎 李珺[1] 王璇 刘雅茜 李佳思 高济越 王弥迦 赵海东[1] Liu Taiyuan;Jiang Lili;Li Jun;Wang Xuan;Liu Yaqian;Li Jiasi;Gao Jiyue;Wang Mijia;Zhao Haidong(Department of Breast Surgery,the Second Affiliated Hospital of Dalian Medical University,Dalian 116023,China)

机构地区：[1]大连医科大学附属第二医院乳腺外科,116023

出　　处：《中华内分泌外科杂志》2020年第5期373-377,共5页Chinese Journal of Endocrine Surgery

基　　金：国家自然科学基金(81772812)。

摘　　要：目的介绍一种保留皮肤的乳腺癌切除术(skin-sparing mastectomy,SSM)联合应用"隐形自然腔隙"术式的一期假体乳房重建手术方法,并探讨其在临床中的应用价值。方法2016年1月至2019年12月,大连医科大学附属第二医院乳腺外科收治72例乳腺癌患者,借助患者的隐形解剖自然腔隙建立假体腔并置入假体(命名为"隐形自然腔隙"术式)进行一期假体乳房重建,分析手术技术特点及重建手术效果。结果70例患者采用保留乳头-乳晕复合体的乳房切除术(nipple-areola complex sparing mastectomy,NSM),2例患者因术中冰冻病理提示乳头下腺体癌浸润将其切除。3例患者出现乳头表皮坏死,所有患者未出现血清肿,切口感染,包膜挛缩等并发症。根据评价量表,乳房术后外观总分平均值为9.39分。各单项平均分为:乳房体积(9.57分)、乳房轮廓(9.43分)、植入物的位置(9.84分)、瘢痕(9.38分)、下极投影(9.27分)及乳房下皱襞外形(9.21分)。BREAST-Q量表评价结果在社会心理学表现分量表中,中位分数为77分。在对乳房的满意度分量表中,中位分数为71分。结论"隐形自然腔隙"术式是一种操作简便、安全性好、可行性高、组织创伤小、美学效果满意的一期假体乳房重建术式,适于开展和推广。Objective To introduce a surgical technique of implant-based immediate breast reconstruction using the"latent orifice"procedure after skin-sparing mastectomy and to investigate the clinical value of this procedure.Methods Clinical data of 72 patients who underwent immediate breast reconstruction using the"latent orifice"procedure(we placed the silicone prosthesis in a"latent orifice"consisting of fascia and underlying muscles)from Jan.2016 to Dec.2019 were collected.Characteristics of surgical technique and the effect of the reconstruction surgery were analyzed.Results 70 patients underwent nipple-areola complex sparing mastectomy(NSM).Two patients’nipples were resected due to intraoperative frozen pathology suggesting carcinoma existing in the nipples.The nipple epidermal necrosis occurred in 3 patients.No seroma,incision infection or capsular contracture occurred.According to the evaluation scale,the overall aesthetic score was 9.39 points.The average score of each subscale was:9.57 points for breast volume,9.43 for breast contour,9.84 for placement of implant,9.38 for scars,9.27 for lower pole projection and 9.21 for inframammary fold definition.BREAST-Q questionnaires were filled by patients.Scores of psychosocial well-being ranged from 62 to 93 points,with the median score of 77 points.Satisfaction with breasts scores ranged from 58 to 100 points,with the median score of 71 points.Conclusion The"latent orifice"procedure is a simple,safe,practicable,aesthetic and satisfying type of immediate implant-based breast reconstruction,which is worth practicing and promoting.

关 键 词：一期乳房重建 乳腺癌 "隐形自然腔隙"术式 乳房浅筋膜系统 保留皮肤的乳腺癌切除术 

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