分层充气法腔镜下胸肌筋膜联合假体一期乳房重建术的技术创新(附2例病例报告)  

Technological innovation of one-stage breast reconstruction with prosthesis implantation and pectoralis fascia flap transplantation through a single incision and stratified aeration with endoscopy(a report of 2 cases)

作　　者：徐飚 王蕾 罗伟 赖凤飞 赖米林 刘晓雁 陈前军 XU Biao;WANG Lei;LUO Wei(Department of Mammary Diseases,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangdong 510120,China)

机构地区：[1]广州中医药大学第二附属医院乳腺科,广东510120 [2]中医证候全国重点实验室,广州中医药大学第二附属医院,广州510120

出　　处：《中国临床新医学》2023年第9期890-895,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：国家自然科学基金项目(编号:81974571);广东省基础与应用基础研究基金项目(编号:2023A1515011115)。

摘　　要：目的探讨免补片经单切口分层充气法腔镜下乳房切除术后一期假体植入联合胸肌筋膜乳房重建的手术方法和临床应用价值。方法回顾性分析2例早期乳腺癌患者的临床资料,分别经侧胸壁切口、腋窝切口入路在腔镜下完成乳房皮下腺体切除术后,完成全腔镜下胸肌筋膜联合假体植入的乳房重建术。观察其手术并发症发生情况,并运用BREAST-Q量表调查患者术前术后满意度。结果2例患者均顺利完成手术,无术后感染、乳头乳晕或皮瓣缺血坏死、假体外露或取出、术后运动畸形、术后胸壁疼痛、包膜挛缩、“波纹”征等并发症。BREAST-Q量表调查结果显示患者均对术后乳房感到满意,除了偶有牵拉感,未报告其他胸壁不适,社会心理状态和性健康状态较术前无明显下降。结论分层充气法腔镜下乳房切除术后胸肌筋膜联合假体植入一期乳房重建可为无条件使用补片的患者提供一种新的技术选择,该方法实现腔镜下分离解剖胸肌筋膜的技术要点,对于部分合适的人群值得进一步探索研究。Objective To explore the surgical method and clinical application value of postmastectomy one-stage prosthesis implantation combined with breast reconstruction with pectoralis fascia through a single incision and stratified aeration with endoscopy.Methods The clinical data of two patients with early breast cancer were retrospectively analyzed.Subcutaneous glandectomy was performed using endoscopy technique by an approach of lateral chest wall incision or axillary incision,and then breast reconstruction with pectoral fascia combined with prosthesis implantation was completed using total endoscopy technique.The surgical complications were observed,and the patients'preoperative and postoperative satisfaction rates were investigated by BREAST-Q survey questionnaire.Results The operations were successfully completed in the two cases.No complications were observed,such as postoperative infection,nipple areola or skin flap ischemic necrosis,prosthesis exposure or removal,postoperative motion abnormalities,postoperative chest wall pain,capsule contracture and“ripple”sign.The results of BREAST-Q survey questionnaire showed that all the patients were satisfied with their breast appearance,except for occasional pulling sensation,and no other chest wall discomfort was reported.The postoperative social psychological status and sexual health status in the two patients were not significantly reduced compared with those before surgery.Conclusion One-stage prosthesis implantation combined with breast reconstruction with pectoralis fascia through a single incision can provide a new option for breast cancer patients who can not paid for patches.This method solves the technical points of separating the pectoral fasciatotally using endoscopy technique and is worth further exploration and research for some suitable populations.

关 键 词：乳腺肿瘤 胸腔镜 假体植入 胸肌筋膜 乳房重建 新技术 

分 类 号：R737.9[医药卫生—肿瘤]