保留乳头的乳头内病变乳管剜出术用于乳腺癌保留乳房皮肤手术的前瞻性队列研究  

Application of mammary-duct exenteration of nipple-skin-sparing mastectomy for breast cancer:A prospective cohort study

作　　者：梁法清[1,2] 贺涛 谢妍妍 吕青[1,2] LIANG Faqing;HE Tao;XIE Yanyan;LÜQing(Department of Breast Surgery,West China Hospital,Sichuan University,Chengdu,610041,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]四川大学华西医院乳腺疾病中心,成都610041

出　　处：《中国胸心血管外科临床杂志》2024年第8期1133-1138,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：四川大学华西医院1·3·5项目(ZYJC18018);四川省科技厅项目(2022YFQ0003);华西医院临床研究孵化项目(21HXFH011);成都市科技局项目(2019-YF05-01082-SN)。

摘　　要：目的探索伴有乳头溢液或中央区病变但肿瘤未累及乳头乳晕皮肤的乳腺癌患者行保留乳头的乳头内病变乳管剜出术的可行性及初步的肿瘤学安全性。方法前瞻性纳入2018年5月—2023年11月四川大学华西医院作者医疗组伴有乳头溢液或中央区病变、但术前影像学评估肿瘤未累及乳头乳晕皮肤的乳腺癌患者,行保留乳头乳晕皮肤的乳腺皮下腺体切除,同时在乳头顶部行1个直径3~4 mm的圆形切口剜出乳头内病变乳管,再塑形乳头;同时收集患者的临床资料,统计患者的早期并发症、随访肿瘤学疗效,并用乳房整形者生活质量测定量表(BREAST-Q)分析患者对乳头美观度的评价。结果共对39例女性患者实施该手术。年龄27~57(39.0±7.6)岁。术后乳腺癌病理分期:0期2例(5.1%),Ⅰ期1例(2.6%),ⅡA期15例(38.5%),ⅡB期21例(53.8%)。肿瘤类型:单纯原位癌5例(12.8%),浸润癌14例(35.9%),其中浸润癌同时伴有原位癌20例(51.3%)。术后3例(7.7%)患者出现乳头轻度缺血所致去色素化;无乳头坏死丢失;术后1例(2.6%)患者出现乳头重建失败(无乳柱,术后外敷料压迫所致乳柱消失);全组患者均未出现切口并发症、皮下气肿、乳房内血肿,有2例(5.1%)因假体腔感染,经清创、换药、重新引流等导致假体外露而行假体取出及乳头乳晕多余皮肤切除术。中位随访时间15.0(2~66)个月。截至2024年4月,随访期间未发现肿瘤复发或转移。BREAST-Q评分显示,患者对乳头的满意度达97.4%。结论伴有乳头溢液或中央区病变但影像学评估肿瘤未累及乳头乳晕皮肤的乳腺癌患者,采取保留乳头乳晕皮肤的乳头内病变乳管剜出的乳腺癌皮下腺体切除假体乳房重建手术,在不增加近期肿瘤复发转移风险的前提下,提高了术后乳房局部尤其是乳头乳晕复合体的美容效果和患者满意度。Objective To investigate feasibility and preliminary oncological safety of surgical innovations in breast cancer patients who have undergone nipple-skin-sparing mastectomy(NSSM)for nipple discharge or central lesions and tumors that do not involve the nipple-areola skin.Methods Between May 2018 and November 2023,patients diagnosed with breast cancer presenting nipple discharge or lesions in the central area underwent NSSM.The imaging assessment revealed no involvement of the nipple-areola-skin by the tumor.We performed a surgical removal of the affected mammary duct and simultaneously made a circular incision measuring 3-4 mm in diameter at the apex of the nipple.The study also involved the collection of clinical data,early complications,oncological outcomes and conducting aesthetic analysis of the nipple using the BREAST-Q scale.Results The surgical procedure was conducted on a cohort of 39 female patients at age of 27-57(39.0±7.6)years.The postoperative pathological stages of breast cancer were distributed as follows:stage 0 in 2 patients(5.1%),stageⅠin 1 patients(2.6%),ⅡA stage in 15 patients(38.5%),ⅡB stage in 21 patients(53.8%).Tumor type:simple carcinoma in situ in 5 patients(12.8%),invasive carcinoma in 14 patients(35.9%),including invasive carcinoma with carcinoma in situ in 20 patients(51.3%).During the median follow-up period of 15.0(2-66)months,3 patients(7.7%)developed decolorization caused by mild nipple ischemia;there was no nipple necrosis;1 patient(2.6%)failed nipple reconstruction(no milk column,the milk column disappeared due to external dressing compression after operation).There were no incision complications,subcutaneous emphysema or intramammary hematoma in all patients.Two patients(5.1%)underwent prosthesis removal and nipple areola excess skin resection because of prosthesis cavity infection and final exposure caused by debridement,dressing change,redrainage and so on.As of April 2024,no tumor recurrence or metastasis was found during the follow-up period.The satisfaction of patient

关 键 词：乳头溢液 乳头内病变乳管剜出术 保留乳头乳晕皮肤的乳腺皮下切除 

分 类 号：R737.9[医药卫生—肿瘤]