保留乳头乳晕复合体的乳房切除术联合术中放疗安全性及疗效评估  

Safety and outcome evaluation of nipple⁃areola complex sparing mastectomy with intraoperative radiotherapy

作　　者：彭浩杰 孙德汛 曾涛[1] 梁汾梅 陈欣欣[1] Peng Haojie;Sun Dexun;Zeng Tao;Liang Fenmei;Chen Xinxin(Department of Breast Surgery,Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院乳腺外科,广东广州510260

出　　处：《广州医科大学学报》2022年第5期52-57,共6页Academic Journal of Guangzhou Medical University

基　　金：国家自然科学基金青年项目(81802817)。

摘　　要：目的:探讨保留乳头乳晕复合体(NAC)的乳房切除术联合术中放疗(IORT)安全性及近期疗效。方法:收集2016年9月~2021年4月在广州医科大学附属第二医院行保留乳头乳晕复合体的乳房切除术(NSM)的女性乳腺癌患者相关临床数据,共38例,其中行IORT 25例,未行IORT 13例,分析这些病例的局部复发率、无复发生存率、总生存率、术后NAC颜色以及感觉改变,伤口愈合情况、患者对乳房术后外观的整体满意度。结果:中位随访时间26.1月,其中无IORT组有1例(7.7%)发生局部复发及远处转移,IORT组无发生局部复发及远处转移,IORT组患者NAC外观(颜色改变)、感觉减退与无IORT组患者无明显差异(均P>0.05),IORT组有2例(8.0%)患者发生乳头坏死,无IORT组有1例(7.7%)患者发生乳头坏死,两组之间的差异不具有统计学意义(P>0.05),IORT组患者伤口愈合拆线时间,引流管留置时间以及术后发热情况与无IORT组无明显差异(均P>0.05)。结论:NSM是对传统乳腺癌乳房切除术及保乳手术的补充,NSM联合IORT不增加乳头褪色以及感觉减退的风险,没有明显增加乳头坏死的机会,总体安全性可控,患者可以获得较高满意度的术后乳房外观。Objective:To investigate the safety and short⁃term outcomes of nipple⁃areola complex(NAC)⁃sparing mastectomy(NSM)combined with intraoperative radiotherapy(IORT).Methods:The clinical data of female patients with breast cancer who underwent NSM in the Second Affiliated Hospital of Guangzhou Medical University betweeen September 2016 and April 2021 were retrieved.There were 38 patients in total,of whom,25 received IORT while 13 did not.The local recurrence rate,recurrence⁃free survival rate,overall survival rate,postoperative alterations in color and sensation of NAC,wound healing,and overall satisfaction with cosmetic appearance after breast surgery were investigated in these patients.Results:The median follow⁃up time was 26.1 months.Among the patients,local recurrence and distant metastasis occurred in 1(7.7%)patient in the non⁃IORT group vs none in the IORT group.The NAC appearance(color alteration)and sensation were comparable between patients who received IORT and those who did not(both P>0.05).Nipple necrosis occurred in 2 patients(8.0%)in the IORT group vs 1(7.7%)in the non⁃IORT group,with no statistically significant difference(P>0.05).There were also no significant differences between the IORT and the non⁃IORT groups in terms of time to wound healing and suture removal,duration of drainage tube indwelling and postoperative fever(all P>0.05).Conclusion:NSM is a complementary option to conventional breast cancer mastectomy and breastconserving surgery.NSM combined with IORT does not increase the risk of nipple depigmentation and hypoesthesia,nor significantly increase the chance of nipple necrosis.The overall safety of NSM is controllable.Patients undergoing NSM may experience higher satisfaction with cosmetic appearance of the breast after surgery.

关 键 词：乳腺癌 保留乳头乳晕复合体的乳房切除术 术中放疗 

分 类 号：R655.8[医药卫生—外科学]