基于华西三号孔的腋窝入路腔镜乳腺良性肿瘤切除及恶性肿瘤保乳术技巧与疗效分析  

Surgical technique and clinical effect of endoscopic assisted transaxillary breast tumor resection with the help of HUAXI Hole 3

作　　者：邱梦雪 杨焕佐 周娇 冯玉 覃湘泉 李娟[1,2] 刘馨然[1] 徐莉 杜正贵[1,3] QIU Mengxue;YANG Huanzuo;ZHOU Jiao;FENG Yu;QIN Xiangquan;LI Juan;LIU Xinran;XU Li;DU Zhenggui(Department of Breast Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Breast Surgery,Sichuan Academy of Medical Sciences·Sichuan Province People’s Hospital,Chengdu,610072,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]四川省医学科学院·四川省人民医院乳腺外科,成都610072 [3]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》2023年第3期350-356,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川省科学技术厅项目(2021YFS0104)。

摘　　要：目的探讨腋窝入路腔镜乳腺良性肿瘤切除及恶性肿瘤保乳术的手术方法及临床效果。方法回顾性分析2020年9月—2021年12月四川大学华西医院乳腺外科收治的18例腔镜乳腺肿瘤切除术患者的临床资料,包括7例良性肿瘤(乳房良性肿瘤组)和11例早期乳腺癌(乳房恶性肿瘤组),评估其手术可行性、肿瘤安全性及术后美容效果,并采用Breast-Q及Scar-Q量表分析患者术后生活质量及满意度。结果18例女性患者均顺利完成手术,其中12例为日间手术。乳房良性和恶性肿瘤组的平均年龄分别为(29.6±11.6)岁、(46.7±14.3)岁,病理检测平均肿瘤大小分别为(3.3±2.1)cm、(2.0±0.8)cm,手术时间分别为(138.9±57.0)min、(177.3±46.3)min。乳房恶性肿瘤组1例切缘阳性行术中扩大切除。患者术后均获随访,乳房良性和恶性肿瘤组平均随访时间分别为(6.8±4.0)个月和(8.7±4.9)个月,均未出现明显术后并发症及肿瘤复发转移。患者的社会心理健康、性生活满意度、胸部功能满意度及乳房外形满意度在术后1个月稍有下降,于术后1年基本恢复至术前状态,疤痕外观满意度评分术后1年上升至(64.6±5.9)分。结论腋窝入路腔镜乳腺肿瘤切除术在保证手术安全性的基础上,可有效改善术后美容效果和患者满意度。Objective To explore the surgical technique and clinical effect of endoscopic assisted transaxillary breast tumor resection in the treatment of benign and malignant breast tumors.Methods The clinical data of 18 patients received endoscopic breast tumor resection from September 2020 to December 2021 in the Department of Breast Surgery,West China Hospital,Sichuan University,were retrospectively analyzed to evaluate the feasibility,tumor safety and postoperative cosmetic effect.There were 7 patients with benign breast tumors(a benign breast tumor group)and 11patients with early breast cancer(a malignant breast tumor group).Breast-Q and Scar-Q questionnaires were used to evaluate postoperative quality of life and satisfaction of patients.Results Endoscopic breast tumor resection was performed successfully in 18 female patients,among whom 12 patients received day surgery.The mean age of benign and malignant breast tumor groups was 29.6±11.6 years and 46.7±14.3 years,the mean tumor size in pathological examination was 3.3±2.1 cm and 2.0±0.8 cm,and the operative time was 138.9±57.0 min and 177.3±46.3 min,respectively.One patient had positive resection margin and underwent intraoperative extended resection in the malignant breast tumor group.All the patients were successfully followed up,and the mean follow-up time of benign and malignant breast tumor groups was6.8±4.0 months and 8.7±4.9 months,respectively.No complications or tumor recurrence occurred.The scores of psychosocial status,sexual well-being,chest wall status and breast satisfaction decreased one month after surgery and basically recovered to the preoperative level in one year,and the score of scar appearance increased to 64.6±5.9 points one year postoperatively.Conclusion Endoscopic assisted transaxillary breast tumor resection can effectively improve postoperative cosmetic effect and patient satisfaction on the premise of safety.

关 键 词：乳腺癌 乳房良性肿瘤 腔镜 保乳手术 乳腺肿瘤切除术 

分 类 号：R737.9[医药卫生—肿瘤]