三蒂法缩乳上提术在乳腺癌伴中度以上生理性乳房肥大和/或中重度乳房下垂患者中的应用研究  

Application of three-pedicle reduction mammaplasty in breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis

作　　者：冯玉 李娟[2] 张栋林[3] 周娇 覃湘泉 刘馨然 邱梦雪 杨焕佐 杜正贵[1,4] FENG Yu;LI Juan;ZHANG Donglin;ZHOU Jiao;QIN Xiangquan;LIU Xiran;QIU Mengxue;YANG Huanzuo;DU Zhenggui(Department of Breast Surgery,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Department of Breast Surgery,Sichuan Academy of Medical Sciences·Sichuan Province People’s Hospital,Chengdu Sichuan,610072,P.R.China;Department of General Surgery,the Fourth People’s Hospital of Sichuan Province,Chengdu Sichuan,610016,P.R.China;Breast Disease Research Center,West China Hospital,Sichuan University,Chengdu Sichuan,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]四川省医学科学院·四川省人民医院乳腺外科,成都610072 [3]四川省第四人民医院普外科,成都610016 [4]四川大学华西医院乳腺疾病研究中心,成都610041

出　　处：《中国修复重建外科杂志》2021年第12期1595-1602,共8页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨三蒂法缩乳上提术治疗乳腺癌伴中度以上生理性乳房肥大和/或中重度乳房下垂患者的临床疗效。方法回顾分析2019年1月—2021年3月采用倒T形切口三蒂法缩乳上提术治疗的15例中度以上乳房肥大和/或中重度乳房下垂的女性乳腺癌患者。患者年龄31~58岁,中位年龄39岁。病程10 d~9个月,中位病程3.4个月。肿瘤均为单发,最大径0.5~3.9 cm,平均2.0 cm。浸润性癌12例、原位癌3例;肿瘤分期:T_(is)N_(0)M_(0)3例,T_(1)N_(0)M_(0)4例,T_(1)N_(2)M_(0)2例,T_(2)N_(0)M_(0)4例,T_(2)N_(1)M_(0)2例。术前患者罩杯大小为D罩杯3例、DD罩杯1例、E罩杯2例、EE罩杯2例、F罩杯2例、FF罩杯1例、≥G罩杯4例。术前乳头至乳房下皱襞距离为8~18 cm,平均12.2 cm。术后定期随访,评估缩乳情况及并发症发生情况,采用乳腺癌患者报告结局量表(BREAST-Q)评价患者满意度及生活质量,并行乳腺专科彩超、胸腹部CT、全身骨扫描等检查,评估肿瘤局部复发或远处转移情况。结果术后乳头位置均略高于乳房下皱襞。术后患者罩杯大小为A罩杯3例,B罩杯6例,C罩杯4例,D罩杯1例,DD罩杯1例,与术前比较差异有统计学意义(Z=3.420,P=0.001)。15例患者均获随访,随访时间6~33个月,中位时间9个月。2例(13.3%)出现术区蜂窝织炎,1例(6.7%)发生轻度脂肪液化,2例(13.3%)术后出现乳头感觉减退但在术后3个月有所恢复;无患者出现脂肪坏死、乳头乳晕复合体或皮瓣坏死等并发症。15例患者均已行辅助放疗,其中1例(6.7%)患者在放疗后出现乳房皮肤颜色改变,所有患者均未出现严重放疗不良事件并发症。无1例患者再次入院或再次手术,也无患者因并发症延缓辅助治疗。BREAST-Q评分中,术后3、6个月的乳房满意度及生活质量评分显著优于术前及术后1个月(P<0.05);术后1个月与术前比较差异均无统计学意义(P>0.05)。术后1、3、6个月乳头满意度评分分别为(15.6±2.2)�Objective To explore the application and effectiveness of three-pedicle reduction mammoplasty in breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis.Methods The clinical data of 15 breast cancer female patients with hypertrophy and/or moderate-to-severe breast ptosis treated by three-pedicle reduction mammaplasty with inverted T incision between January 2019 and March 2021 were retrospectively analysed.The patients were aged 31-58 years,with a median age of 39 years.The disease duration ranged from 10 days to 9 months(median,3.4 months).All patients had unifocal tumor,with a maximum diameter of primary tumor of 0.5-3.9 cm(mean,2.0 cm),of which 12 were diagnosed with invasive carcinoma and 3 carcinoma in situ.Tumor stage:TisN0M0 in 3 cases,T1N0M0 in 4 cases,T1N2M0 in 2 cases,T2N0M0 in 4 cases,and T2N1M0 in 2 cases.The preoperative cup sizes of patients were D cup in 3 cases,DD cup in 1 case,E cup in 2 cases,EE cup in 2 cases,F cup in 2 cases,FF cup in 1 case,and≥G cup in 4 cases.The distance from nipple to inframammary fold was 8-18 cm(mean,12.2 cm)before operation.The patients were followed up regularly after operation to evaluate the breast reduction effect and complications;Breast cancer reporting outcome scale(BREAST-Q)was used to assess patients’satisfaction and quality of life;and ultrasound,chest and abdominal CT,whole-body bone scan were performed to assess local tumor recurrence or distant metastasis.Results The postoperative nipple position was slightly higher than inframammary fold in all patients.Postoperative cup sizes were A cup in 3 cases,B cup in 6,C cup in 4,D cup in 1,and DD cup in 1,which showing significant difference when compared with preoperative cup sizes(Z=3.420,P=0.001).The median follow-up time was 9 months(range,6-33 months).Postoperatively,2 cases(13.3%)had wound-site cellulitis,1(6.7%)had mild fat liquefaction,2(13.3%)had nipple and areola hypoesthesia but recovered after 3 months.No complication such as fat necrosis,papillary

关 键 词：乳腺癌 乳房肥大 乳房下垂 三蒂法 缩乳上提术 

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