电刀热分离和锐性冷分离用于腔镜假体乳房重建术皮瓣游离的有效性和安全性对比研究  

A comparative study of electrocautery thermal dissection versus sharp cold dissection for flap elevation during endoscopic-assisted breast reconstruction

作　　者：唐甜甜[1] 刘政华 王辰 易心璐 周涛[1] 耿翠芝[1] 宋振川[1] 马力[1] TANG Tian-tian;LIU Zheng-hua;WANG Chen;ZHOU Tao(Breast Center,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050035,China)

机构地区：[1]河北医科大学第四医院乳腺中心,河北石家庄050035

出　　处：《中国实用外科杂志》2024年第11期1269-1275,共7页Chinese Journal of Practical Surgery

基　　金：国家卫生健康委医药卫生科技发展研究中心项目(No.WKZX2024CX1032206)。

摘　　要：目的比较腔镜乳腺切除即刻一期假体乳房重建术皮瓣游离过程中使用热分离法和冷分离法的安全性及短期预后。方法回顾性分析2022年1月至2024年8月河北医科大学第四医院乳腺中心收治的早期乳腺癌接受腔镜乳腺切除即刻一期假体乳房重建的228例病人的临床资料,根据皮瓣游离使用器械分为热分离组及冷分离组。CUSUM学习曲线分析两组腔镜乳腺切除+前哨淋巴结活检术跨越学习曲线所需累计的最少手术例数,以确定两组最终纳入例数。比较两组病人临床病理资料、手术相关数据、术后并发症及局部复发情况等。结果CUSUM学习曲线分析结果显示,随手术例数增加冷分离组手术时长无明显变化趋势;热分离组病人n=26时CUSUM曲线达到最佳拟合优度(P<0.001),前26例病人术后并发症(切口感染、假体外露、皮瓣坏死)的发生率显著高于其余病人,差异有统计学意义(30.8%vs.7.4%,P=0.016)。最终冷分离组纳入70例,热分离组106例。两组病人临床病理资料比较差异无统计学意义(P>0.05)。与热分离组相比,冷分离组手术时长更短[(132.7±28.3)min vs.(158.5±38.0)min,P<0.001],出血量更大[(30.9±17.6)mL vs.(22.4±13.7)mL,P<0.001],差异有统计学意义。两组病人术后出血比例及拔管时间、乳头后方阳性比例及术后感染、假体外露、皮瓣坏死、乳头乳晕缺血坏死、包膜挛缩的发生率差异无统计学意义(P>0.05)。所有病人中位随访7.1(范围13~94)个月,热分离组出现局部复发1例,冷分离组无局部复发病例,两组均未发现远处转移病例。结论热分离法和冷分离法游离皮瓣在腔镜乳腺切除即刻一期假体乳房重建中均安全有效。冷分离法时间更短,但术中及术后发生出血的风险增加,热分离法需要一定学习曲线。Objective To compare the safety and short-term prognosis of thermal and cold dissection in flap elevation for immediate implant-based breast reconstruction by endoscopic mastectomy.Methods The clinical data of 228 patients with early-stage breast cancer who underwent immediate endoscopic breast reconstruction between January 2022 and August 2024 at the Fourth Hospital of Hebei Medical University were retrospectively analyzed.Patients were divided into the thermal separation group and the cold separation group based on the instruments used for flap dissection.The CUSUM learning curve was used to analyze the minimum cumulative number of surgeries required for endoscopic assisted mastectomy and sentinel lymph node biopsy across the learning curve in both groups to determine the final number of included cases in both groups.Clinical and pathological factors,intraoperative information,postoperative complications,and local recurrence were analyzed and compared between the two groups.Results The analysis of CUSUM learning curve showed no significant trend in surgery duration with the increasing number of surgical cases in the cold separation group.In contrast,the CUSUM curve for the thermal separation group achieved the optimal fit at n=26(P<0.001)and the first 26 patients obviously had a higher incidence of postoperative complications(incision infection,prosthesis exposure,flap necrosis)compared with other patients in this group,with a significant difference(30.8%vs.7.4%,P=0.016).Ultimately,70 patients in the cold separation group and 106 patients in the thermal separation group were included.There were no statistically significant differences between the two groups in the clinical and pathological characteristics(P>0.05).Compared to the thermal separation group,the cold separation group showed a shorter operative time[(132.7±28.3)min vs.(158.5±38.0)min,P<0.001],but had more blood loss[(30.9±17.6)mL vs.(22.4±13.7)mL,P<0.001],and the differences were statistically significant.No statistically significant differences

关 键 词：乳腺肿瘤 乳房植入物 乳房重建术 皮瓣游离 术后并发症 

分 类 号：R6[医药卫生—外科学]