腋窝入路腔镜下乳腺癌皮下腺体切除联合胸肌前假体+补片Ⅰ期乳房重建的创新探索  

An innovative exploration of endoscopic nipple-sparing mastectomy combined with immediate pre-pectoral implant-based breast reconstruction with TiLoop Bra via single axillary incision for breast cancer patients

作　　者：覃湘泉 王甜甜 谢妍妍 梁法清[1] 冯玉 周娇 黄艺璇 李娟[1] 邱梦雪 张颂博 文楠 周宇婷[1] 杨焕佐 吕青[1,2] 杜正贵[1,2] QIN Xiangquan;WANG Tiantian;XIE Yanyan;LIANG Faqing;FENG Yu;ZHOU Jiao;HUANG Yixuan;LI Juan;QIU Mengxue;ZHANG Songbo;WEN Nan;ZHOU Yuting;YANG Huanzuo;LV Qing;DU Zhenggui(Department of Breast Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Center for Breast Disease Treatment,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院乳腺外科,成都610041 [2]四川大学华西医院乳腺疾病治疗中心,成都610041

出　　处：《中国胸心血管外科临床杂志》2021年第9期1029-1036,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川省科学技术厅项目(2019YFH0146,2020YFS0199,2021YFS0104)。

摘　　要：目的探讨腋窝入路腔镜下乳腺癌皮下腺体切除联合胸肌前假体+补片Ⅰ期乳房重建的手术方法及早期效果。方法回顾性分析2021年3~5月我院收治的9例腋窝入路腔镜下乳腺癌皮下腺体切除联合胸肌前假体+补片Ⅰ期乳房重建女性患者的临床资料,年龄40.6(22~60)岁。统计患者手术时间、早期并发症,并采用BREAST-Q量表分析患者乳房重建前后社会心理健康、对乳房满意度以及胸部功能的差异。结果均为单发肿瘤,平均最大径2.4(0.6~4.7)cm;肿瘤距离乳头平均2.5(2~4)cm。术后临床分期:0期2例,Ⅰ期7例。平均手术时间161.1(125~201)min,平均术中出血量41.1 mL,平均住院时间1.5 d,其中日间患者5例,目前患者均获随访,中位随访时间1(1~2)个月。术后1例(11.1%)患者出现乳头轻度缺血所致去色素化;全组患者均未出现切口并发症、皮下气肿、乳房内血肿形成、感染、乳头乳晕坏死、皮瓣坏死、假体和(或)补片取出。随访期间未发现肿瘤复发或转移。与术前相比,术后1个月胸部功能有所降低,差异有统计学意义(P=0.001),而乳房及社会心理评分差异无统计学意义(P>0.05)。结论腋窝入路腔镜下乳腺癌皮下腺体切除联合胸肌前假体+补片Ⅰ期乳房重建创伤小、术后恢复快、手术时间短、早期并发症少、再乳房美容效果好,采用该技术行乳房重建可获得较高的近期满意度。Objective To explore the surgical technique and preliminary results of endoscopic nipple-sparing mastectomy(E-NSM)and immediate pre-pectoral implant-based breast reconstruction(BR)with titanium-coated polypropylene mesh(TiLoop Bra)via single axillary incision for breast cancer patients.Methods The clinical data of 9 consecutive female patients who underwent E-NSM and immediate pre-pectoral implant-based BR with TiLoop Bra from March to May 2021 were retrospectively analyzed.The mean age of patients was 40.6(22-60)years.The operation time,early complications were collected,and the patients'social and mental health,breast satisfaction and chest function before and after the operation were assessed with the BREAST-Q questionnaire.Results All the patients had unicentric tumor with a mean diameter of 2.4(0.6-4.7)cm.The mean distance from the tumor to the nipple was 2.5(2-4)cm.There were 2 patients with tumor stage 0 and 7 patients with stageⅠ.The mean operation time was 161.1(125-201)min,the mean blood loss was 41.1 mL and the hospital stay time was 1.5 d.There were 5 patients in the day-care unit.All the patients were successfully followed up with a median follow-up time of 1(1-2)month.One(11.1%)patient with depigmentation of the nipple-areola complex caused by mild ischemia.None of the patients had incision complications,subcutaneous emphysema,hematoma,infection,nipple-areola or skin flaps necrosis,implant loss.During the follow-up period,no local/regional recurrence or distant metastasis was found.Chest well-being was decreased in the first month after the surgery compared with preoperative status,and the difference was statistically significant(P=0.001).There was no statistical difference in the breast satisfaction or psychosocial function scores between pre-and post-operation(P>0.05).Conclusion E-NSM and immediate pre-pectoral implant-based BR with TiLoop Bra via single axillary incision has minimal trauma,rapid postoperative recovery,short operation time,few early complications and good early cosmetic effect,a

关 键 词：乳腺癌 腔镜 乳房重建 逆序法 牵引线补片法 

分 类 号：R737.9[医药卫生—肿瘤]