腔镜与开放手术获取背阔肌用于乳房重建的比较研究  

Comparative study of endoscopic surgery and traditional open surgery of latissimus dorsi flap harvesting for breast reconstruction

作　　者：冯玉 罗桂林[1] 梁法清[2,3] 张栋林[1] 杜正贵[2,3] FENG Yu;LUO Guilin;LIANG Faqing;ZHANG Donglin;DU Zhenggui(Department of General Surgery,The Fourth People’s Hospital of Sichuan Province,Chengdu 610016,P.R.China;Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Breast Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川省第四人民医院普通外科,成都610016 [2]四川大学华西医院普通外科,成都610041 [3]四川大学华西医院乳腺疾病中心,成都610041

出　　处：《中国普外基础与临床杂志》2025年第3期293-299,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川大学华西医院临床研究孵化项目(项目编号:2022HXFH004)。

摘　　要：目的对比经腋窝单切口腔镜下皮下腺体切除+腔镜下背阔肌切取即刻背阔肌植入乳房重建术(简称“腔镜组”)与开放手术切取背阔肌即刻背阔肌植入乳房重建术(简称“开放组”)患者的手术资料、安全性、美容学效果及生活质量。方法收集前瞻性维持数据库中2021年1月至2024年6月期间在四川大学华西医院及四川省第四人民医院行背阔肌乳房重建的患者,根据手术方式分为腔镜组和开放组,比较2组患者的基线资料、手术相关资料、术后并发症及患者报道结局量表(BREAST-Q量表)评分结果。结果共收集到73例患者,其中腔镜组23例、开放组50例,2组患者除开放组中T4分期者占比较腔镜组高(P<0.001)外,其他如年龄、身体质量指数、乳房下垂、肿瘤位置、肿瘤N分期、病理类型、辅助治疗等比较差异均无统计学意义(P>0.05)。腔镜组较开放组可以切取更长的背阔肌(P=0.002)。2组患者的总外科并发症、主要并发症、次要并发症及植入物相关并发症比较差异均无统计学意义(P>0.05),2组患者最常见的并发症均为背部积液,腔镜组5例(21.7%),开放组11例(22.0%);主要并发症在腔镜组中未出现,在开放组中2例出现(1例患者因背阔肌缺血坏死、1例患者因乳房感染而导致植入物取出)。腔镜组的切口总长度明显小于开放组(P<0.001),腔镜组患者乳房满意度(P=0.045)、背部满意度(P<0.001)及性生活健康(P=0.028)评分均显著高于开放组。随访期内,开放组中有3例(6.0%)患者出现远处转移(均为肺转移),腔镜组中未出现局部或区域复发、远处转移及乳腺癌特异性死亡。结论本研究结果提示,对于皮肤有侵犯而渴望乳房重建或假体重建失败(如皮瓣缺血坏死)患者,开放手术取背阔肌是值得选择的手术方式。但是对于不需要额外皮肤乳房重建的乳腺癌患者,腔镜下取背阔肌乳房重建在美容学效果方面存在较大优势,Objective To compare the surgical data,safety,cosmetic outcomes,and quality of life of patients underwent single axillary incision endoscopic nipple-sparing mastectomy and immediate breast reconstruction with endoscopic harvesting of latissimus dorsi muscle flap(abbreviation as the“endoscopic group”)and traditional open surgery of latissimus dorsi muscle flap harvesting for breast reconstruction after mastectomy(abbreviation as the“open group”).Methods The patients were collected,who underwent latissimus dorsi breast reconstruction at the West China Hospital of Sichuan University and the Fourth People’s Hospital of Sichuan Province from January 2021 to June 2024 from a prospective maintenance database,and then were assigned into an endoscopic group and open group according to the surgical method.Their basic information,information relevant operation,postoperative complications,and patient reported outcomes(BREAST-Q scale)score were compared between the two groups.Results A total of 73 patients were enrolled,including 23 patients in the endoscopic group and 50 patients in the open group.There were no statistically significant differences in the age,body mass index,breast sagging,tumor location,tumor N stage,pathological type,adjuvant therapy,etc.between the patients of two groups,except for a higher proportion of T4 stage patients in the open group as compared with the endoscopic group(P<0.001).A longer size of latissimus dorsi muscle flap was harvested in the endoscopic group as compared with the open group(P=0.002).There were no statistically significant differences in the total surgical complications,major complications,minor complications,and implant-related complications between the patients of two groups(P>0.05).The most common complication in the patients of both groups was back seroma,21.7%(5/23)in the endoscopic group and 22.0%(11/50)in the open group.The total length of incisions in the endoscopic group was significantly shorter than that in the open group(P<0.001),and the points of the breast

关 键 词：背阔肌 乳房重建 腔镜 开放手术 

分 类 号：R73[医药卫生—肿瘤]