腔镜下乳腺癌根治术并全胸肌后乳房植入物重建的临床应用  

Clinical application of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants

作　　者：贺湘眉 侯兰 王东辉 杨柳 李丹玺 秦元 张明坤 赵戈 张欢 张聚良 HE Xiangmei;HOU Lan;WANG Donghui;YANG Liu;LI Danxi;QIN Yuan;ZHANG Mingkun;ZHAO Ge;ZHANG Huan;ZHANG Juliang(Department of Thyroid and Mammary Vascular Surgery,the First Affiliated Hospital of Air Force Military Medical University,Xi’an Shaanxi,710032,P.R.China)

机构地区：[1]空军军医大学第一附属医院甲乳血管外科,西安710032

出　　处：《中国修复重建外科杂志》2024年第7期786-792,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：陕西省重点研发计划项目(2021SF-101)。

摘　　要：目的探讨腔镜下乳腺癌根治术并全胸肌后乳房植入物重建的临床效果。方法回顾分析2019年4月—2023年12月收治且符合选择标准的138例女性乳腺癌患者临床资料。患者年龄27~61岁,平均43.8岁;肿瘤最长径1.00~7.10 cm,平均2.70 cm。病理学检查示雌激素受体阳性108例,孕激素受体阳性108例,人表皮生长因子受体2阳性40例。均行腔镜下乳腺癌根治术并全胸肌后乳房重建手术治疗。记录患者手术时间、术中出血量、假体大小,以及乳头乳晕复合体(nipple-areola complex,NAC)缺血、皮瓣缺血、感染及包膜挛缩等情况;使用Breast-Q2.0评分量表行乳房美学、满意度及生活质量评估(包括乳房满意度评分、社会心理健康评分和胸部疼痛评分)。根据该技术开展后实施手术的时间,将患者分为第1年内手术组(A组25例)和1年后手术组(B组113例),比较两组上述结局指标;根据术后随访时间将患者分为短期组(随访时间<1年)和长期组(随访时间≥1年),比较两组基线资料及术后Breast-Q2.0评分。结果患者手术时间平均120.76 min,术中出血量平均23.77 mL,假体大小平均218.37 mL。术后发生NAC缺血21例(15.22%),皮瓣缺血30例(21.74%),感染23例(16.67%),包膜挛缩33例(23.91%),假体取出2例(1.45%)。除A组手术时间显著长于B组(P<0.05)外,两组术中出血量、假体大小及相关并发症发生情况比较差异均无统计学意义(P>0.05)。所有患者均获随访,随访时间3~48个月,平均20个月;其中短期组33例,长期组105例,两组患者年龄、身体质量指数、绝经例数、新辅助化疗例数、腋窝淋巴结清扫例数、乳房罩杯、乳房下垂程度及术后放疗构成比等基线资料比较差异均无统计学意义(P>0.05)。末次随访时,患者Breast-Q2.0评分中乳房满意度评分为33~100分,平均60.9分;社会心理健康评分为38~100分,平均71.3分;胸部疼痛评分为20~80分,平均47.3分。其中长期组患者社会心�Objective To investigate the effectiveness of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants.Methods The clinical data of 138 female patients with breast cancer who met the selection criteria between April 2019 and December 2023 were retrospectively analyzed.The mean age of the patients was 43.8 years(range,27-61 years).The maximum diameter of the tumors ranged from 1.00 to 7.10 cm,with an average of 2.70 cm.Pathological examination showed that 108 cases were positive for both estrogen receptor and progesterone receptor,and 40 cases were positive for human epidermal growth factor receptor 2.All patients underwent endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants.The operation time,intraoperative blood loss,prosthesis size,and occurences of nipple-areola complex(NAC)ischemia,flap ischemia,infection,and capsular contracture were recorded.The Breast-Q2.0 score was used to evaluate breast aesthetics,patient satisfaction,and quality of life(including the social mental health score,breast satisfaction score,and chest pain score).Patients were divided into two groups based on the time of operation after the technique was implemented:group A(within 1 year,25 cases)and group B(after 1 year,113 cases).The above outcome indicators were compared between the two groups.Furthermore,based on the postoperative follow-up duration,patients were classified into a short-term group(follow-up time was less than 1 year)and a long-term group(follow-up time was more than 1 year).The baseline data and postoperative Breast-Q2.0 scores were compared between the two groups.Results The average operation time was 120.76 minutes,the average intraoperative blood loss was 23.77 mL,and the average prosthesis size was 218.37 mL.Postoperative NAC ischemia occurred in 21 cases(15.22%),flap ischemia in 30 cases(21.74%),infection in 23 cases(16.67%),capsular contracture in 33 cases(23.91%),and prosthesis removal

关 键 词：腔镜手术 乳房重建术 乳腺癌根治术 

分 类 号：R737.9[医药卫生—肿瘤]