乳腺癌腔镜辅助对比开放下保留乳头乳晕乳房皮下全切加一期假体植入重建术后假体相关并发症的回顾性队列研究  

A retrospective cohort study of the postoperative prothesis-related complications of single-port endoscopic assisted versus open surgery on nipple sparing mastectomy and immediate prosthesis breast reconstruction

作　　者：李江涛 刘志瀚[1] 刘晨璐 欧欣瑜 陆艺文 苏士成[1] Li Jiangtao;Liu Zhihan;Liu Chenlu;Ou Xinyu;Lu Yiwen;Su Shicheng(Breast Tumor Center,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院乳腺肿瘤中心,广州1510120

出　　处：《中华外科杂志》2024年第2期141-146,共6页Chinese Journal of Surgery

基　　金：国家重点研发计划(2021YFA1300502);国家自然科学基金(92057210,82125017,91942309,82002780);广州市科技计划(202103000070,202201020479);腾讯基金会科学探索奖。

摘　　要：目的探讨乳腺癌腔镜辅助与开放下保留乳头乳晕乳房皮下全切加一期假体植入重建术后假体相关并发症、术后短期手术效果及患者满意度。方法本研究为回顾性队列研究。回顾性分析2021年8月至2022年8月在孙逸仙纪念医院乳腺肿瘤中心住院行保留乳头乳晕皮下全切加一期假体植入重建的104例女性乳腺癌患者的临床资料。根据手术方式将患者分为腔镜组(53例)和开放组(51例)。腔镜组患者年龄(43.3±9.9)岁(范围:25~66岁),开放组患者年龄(39.9±7.8)岁(范围:25~54岁)。记录两组患者的手术时间、手术后住院时间、术后出血量、术后2 d引流量及术后患者对乳房重建的满意度。采用Wilcoxon秩和检验比较两组乳房重建满意度,并探讨两种术式术后假体相关并发症发生情况与处理经验。结果腔镜组53例患者中未发生术后假体感染、假体取出及乳头乳晕缺血坏死,1例患者发生术后切口出血,予重新缝合切口,切口愈合良好。开放组51例患者中发生5例术后假体感染;其中2例行二次手术取出假体并予足量抗菌药物治疗,1例置管引流合并抗菌药物治疗,其余2例行单纯抗菌药物治疗,治疗后感染均好转;发生1例术后乳头乳晕缺血坏死,嘱患者定期返院消毒换药处理后坏死区域逐渐恢复;1例术后切口出血,重新缝合后愈合。腔镜组患者对乳房假体植入术后的美容效果满意度更高(Z=-4.511,P<0.01)。结论腔镜辅助与开放行保留乳头乳晕皮下腺体全切加一期假体植入重建手术均可获得较好效果,术后假体相关并发症例数较少。腔镜术后患者对乳房重建美容效果满意度更高。Objective To examine the postoperative prosthesis-related complications,short-term surgical outcomes and patient satisfaction with breast reconstruction between patients who underwent endoscopic assisted versus conventional nipple sparing mastectomy and immediate prothesis breast reconstruction.Methods This study was a retrospective cohort study.A retrospective analysis was performed on clinical data of 104 women with breast cancer who received nipple sparing mastectomy and immediate prothesis breast reconstruction from August 2021 to August 2022 at the Breast Tumor Center,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University.They were divided into two groups according to the surgical approach.A total of 53 patients,aged(43.3±9.9)years(range:25 to 66 years),underwent endoscopic nipple sparing mastectomy(E-NSM group)and immediate prothesis breast reconstruction.The other 51 patients aged(39.9±7.8)years(range:25 to 54 years)underwent conventional open surgery(C-NSM group).Short-term surgical outcomes including operation time,postoperative hospital stay,postoperative blood loss,and postoperative drainage volume in 2 days were recorded.Patient satisfaction with breast reconstruction was compared using the Wilcoxon rank sum test.Postoperative prothesis-related complications were investigated to determine the experience to deal with them.Results No postoperative prosthesis-related infection,prosthesis loss,or necrosis of the nipple-areola complex occurred in the E-NSM group,while 1 patient suffered from hematoma,whose wound was skinned with resuture after disinfection.Five patients in the C-NSM group had prosthesis-related infection,2 of them received prosthesis removal surgery combined with sufficient antimicrobial agent,another one underwent surgery for subcutaneous placement of the drain,as well as antimicrobial agent therapy,and the rest of them healed up only with antimicrobial agent therapy.All recovered well after treatment.One patient recovered from necrosis of the nipple-areola complex through periodic iodoph

关 键 词：乳腺肿瘤 假体植入 保留乳头乳晕乳房皮下全切除术 假体相关并发症 单孔腔镜 

分 类 号：R73[医药卫生—肿瘤]