达芬奇机器人辅助保留乳头乳晕乳腺切除即刻假体联合背阔肌组织瓣乳房重建的初步探索  

Preliminary research of Da Vinci robot-assisted nipple sparing mastectomy and immediate breast reconstruction with gel implant and the latissimus dorsi muscle flap

作　　者：陈阔 吕鹏威[1] CHEN Kuo;LYU Pengwei(Department of Breast Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院乳腺外科,河南省郑州市450052

出　　处：《组织工程与重建外科》2024年第5期522-527,共6页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的探索机器人辅助保留乳头乳晕乳腺切除即刻假体联合背阔肌组织瓣(LDMF)乳房重建手术的有效性和实用性。方法回顾性分析了单一医疗机构自2022年9月至2023年9月期间完成的14例机器人辅助的背阔肌组织瓣乳房重建。其中有皮岛组5例、无皮岛组9例。统计各组病例的手术类型、手术时间和围手术期并发症。结果在全部14例手术中,8例进行了对侧乳房的整形手术,1例患者没有使用假体。有皮岛组和无皮岛组的平均手术总时间分别为(392.1±61.2)min和(351.6±67.4)min,术后留置引流管时间分别为(11.2±0.7)d和(9.0±1.1)d,住院时间分别为(18.4±1.5)d和(11.3±1.1)d。由于样本量有限及两组患者的手术因含有对侧手术和腋窝手术从而导致偏差,研究结果在统计学上无意义。术后所有患者均未出现乳头乳晕复合体坏死和围手术期并发症。在平均(3±1)个月的随访期间内没有发生复发或死亡病例。所有患者均对术后的美学效果表示满意。结论机器人辅助保留乳头乳晕乳腺切除即刻假体联合背阔肌组织瓣乳房重建手术是安全的,在引流管留置时间和住院时间上无皮岛术式更具优势,且具有良好的美容效果。然而,这项技术仍具有挑战性,需要术者有较长时间的学习曲线。Objective To explore the effectiveness and practicability of robot-assisted nipple sparing mastectomy and immediate breast reconstruction with gel implant and the latissimus dorsi muscle flap(LDMF).Methods A retrospective analysis of 14 robot-assisted breast reconstruction with LDMF completed from September 2022 to September 2023 in a single medical center was conducted.The cohort was divided into two groups:those with skin islands(n=5)and those without(n=9).Variables such as surgical technique,operative duration and perioperative complications were scrutinized.Results The study encompassed 14 patients.Among these,8 underwent contralateral breast reconstruction,and one opted out of using a gel implant.Average total operative times were(392.1±61.2)minutes for the group with island flap and(351.6±67.4)minutes for the group without island flap.And indwelling drains and length of hospital stay were(11.2±0.7)d and(18.4±1.5)d for the group with island flap,(9.0±1.1)d and(11.3±1.1)d for the group without island flap.The findings were statistically insignificant due to the limited sample size and the bias between the two groups caused by the inclusion of contralateral surgery and axillary surgery.There were no postoperative necrosis and perioperative complications of the nipple-areolar complex.No recurrence or death occurred during a mean follow-up of(3±1)months.All patients were satisfied with the aesthetic results after operation.Conclusion Robot-assisted nipple sparing mastectomy and immediate breast reconstruction with gel implant and LDMF is a safe surgical procedure.LDMF without island flap procedure is more advantageous in terms of drain retention time and hospitalization time,and has good cosmetic results.However,the technique remains challenging and requires a long learning curve for the surgeon.

关 键 词：机器人手术 乳房重建 背阔肌肌瓣 凝胶假体 无皮岛皮瓣 

分 类 号：R622[医药卫生—整形外科]