中国修复重建外科杂志

中国修复重建外科杂志

经腋窝切口腔镜下乳房皮下腺体切除联合即刻乳房重建的疗效观察

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目的 介绍一种采用自制单孔通道经腋窝切口于腔镜下行乳房皮下腺体切除术(nipple-sparing mastectomy,NSM)联合即刻乳房重建的手术方法。 方法 2017 年 1 月—2018 年 2 月,收治 15 例乳腺癌女性患者,采用自制单孔通道经腋窝切口于腔镜下行 NSM 联合即刻乳房重建。患者年龄 27~45 岁,平均 37.5 岁。乳腺癌分期 Ⅰ期 5 例、Ⅱ期 10 例。病程 1~24 个月,平均 8 个月。肿瘤位于左侧 8 例、右侧 7 例。肿瘤直径 1.5~3.0 cm,平均 2.6 cm;肿瘤距离乳头 1.8~4.0 cm,平均 2.3 cm。 结果 术后出现乳头表层皮肤坏死 1 例,皮下积液 1 例;均未出现皮下气肿、皮瓣坏死。1 例术后病理检查提示乳头后方组织阳性,行乳头切除。患者均获随访,随访时间 7~17 个月,平均 11 个月。重建乳房外观采用 Harris 评价标准:获优 4 例、良 10 例、一般 1 例。随访期间未发现肿瘤复发或转移。 结论 采用自制单孔通道经腋窝切口于腔镜下行 NSM 联合即刻乳房重建安全可行,美容效果好,为乳腺癌治疗提供了一种新选择。

Objective To introduce an surgical technique of endoscopic nipple-sparing mastectomy (NSM) combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. Methods Between January 2017 and February 2018, 15 female patients with breast cancer (stageⅠ in 5 cases and stage Ⅱ in 10 cases) were treated with endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. They were 27-45 years old (mean, 37.5 years). The disease duration ranged from 1 to 24 months (mean, 8 months). The tumor located at the left breast in 8 cases and at the right breast in 7 cases. The diameter of tumor ranged from 1.5 to 3.0 cm (mean, 2.6 cm). The distance between tumor and nipple was 1.8-4.0 cm (mean, 2.3 cm). Results After operation, the nipple epidermal necrosis occurred in 1 case, and subcutaneous effusion in 1 case. No subcutaneous emphysema or skin flap necrosis occurred. Postoperative pathological examination showed that 1 case was nipple involvement and was treated with nipple resection. All patients were followed up 7-17 months (mean, 11 months). According to the Harris assessment criteria for appearance of reconstructed breast, there were 4 cases of excellent, 10 cases of good, and 1 case of poor. No tumor recurrence or metastasis occurred during follow-up. Conclusion It is a safe and feasible method of endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision, and can obtain good cosmetic results. It is a new option to breast reconstruction.

关键词: 乳腺癌; 乳房皮下腺体切除术; 腔镜; 乳房重建

Key words: Breast cancer; nipple-sparing mastectomy; endoscopy; breast reconstruction

引用本文: 黄贞强, 陈凯, 朱李玲, 曾剑锋, 周志平, 李顺荣. 经腋窝切口腔镜下乳房皮下腺体切除联合即刻乳房重建的疗效观察. 中国修复重建外科杂志, 2018, 32(11): 1458-1462. doi: 10.7507/1002-1892.201804027 复制

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