早期乳腺癌行保留乳头乳晕全乳切除术并一期乳房重建的治疗效果

doi:10.3969/j.issn.2095-378X.2018.01.002

外科研究与新技术 ›› 2018, Vol. 7 ›› Issue (1): 4-8.doi: 10.3969/j.issn.2095-378X.2018.01.002

早期乳腺癌行保留乳头乳晕全乳切除术并一期乳房重建的治疗效果

张辉¹, 林孟波¹, 王金泗¹, 陈晓耕¹, 范跃祖², 郑敏辉¹

1.福建医科大学省立临床医学院肿瘤外科,福州 350001;
2.同济大学附属同济医院普通外科,上海 200065

收稿日期:2018-01-10 发布日期:2019-12-12
通讯作者: 林孟波,电子信箱:yang9903276@163.com
作者简介:张辉(1983—),男,主治医师,硕士,从事临床乳腺肿瘤治疗工作

Clinical efficacy of nipple-sparing mastectomy and immediate breast reconstruction for early breast cancer patients

ZHANG Hui¹, LIN Mengbo¹, WANG Jinsi¹, CHEN Xiaogeng¹, FAN Yuezu², ZHENG Minhui¹

1.Department of Surgery Oncology, Provincial Clinical Institute, Fujian Medical University, Fuzhou 350001, China;
2.Department of Surgery, Tongji Hospital Affiliated to Tongji University, Shanghai 200065, China

Received:2018-01-10 Published:2019-12-12

摘要/Abstract

摘要： 目的探讨保留乳头乳晕复合体(nipple-areolar complex,NAC)并一期乳房重建术治疗早期乳腺癌的疗效、并发症和美容效果。方法选取2010年6月—2014年6月收治的初诊为乳腺癌(0~Ⅱa期)患者共58例,32例接受保留乳头乳晕复合体的乳房切除术(nipple-areola complex-sparing mastectomy,NSM)并一期重建(观察组),26例为不保留乳头乳晕并一期乳房重建(对照组)。术中所有患者均采用假体植入,并以背阔肌肌瓣覆盖,比较两组患者术后的局部复发、远处转移情况、并发症和美容效果。结果两组患者随访时间48～60个月,平均随访时间(52.36±3.51)个月,观察组和对照组均未出现局部复发;观察组发生远处转移1例,对照组远处转移1例,远处转移发生率差异无统计学意义(P>0.05);观察组发生并发症11例,对照组发生并发症7例,观察组并发症发生率略高于对照组,但差异无统计学意义(P>0.05);观察组美容效果评价有26例为“优”,5例为“良”,1例为“一般”,0例为“差”,对照组美容效果评价为“优”的6例,“良”14例,“一般”6例,“差”0例,两组间美容效果差异有统计学意义(P<0.05) 结论严格把握入组条件和手术流程情况下,保留乳头乳晕复合体的乳房切除术并一期乳房重建有助于保持乳房美观及功能,提高患者术后生活质量,具有较高的安全性和可行性。

关键词: 乳腺癌, 乳头乳晕复合体, 一期乳房重建, 并发症

Abstract: Objective To investigate the clinical efficacy, complications, and cosmetic results of reserving the nipple-areola complex (NAC) and immediate breast reconstruction for early breast cancer patients.Methods A total of 58 cases of breast cancer (0 -Ⅱa stage) were retrospectively reviewed in the Department of Surgical Oncology, Fujian Provincial Hospital from June 2010 to June 2014.Of these patients,32 cases underwent nipple-areola complex sparing mastectomy (NSM) and immediate breast reconstruction(observation group), and the other 26 cases underwent modified radical mastectomy and immediate reconstruction (control group).The reconstruction was performed using a prosthetic implant, covered with dorsal latissimus free flap. The local recurrences, distant metastasis, complications and cosmetic outcomes were compared.Results The follow-up time ranged from 48 to 60 months with a mean of 52.36±3.51 months. No local recurrence was found in the two groups. One case of distant metastasis occurred in both the observation group and control group, and there was no significant difference (P>0.05). The postoperative complications were found in 11 cases of the observation group and in 7 cases of the control group, respectively, but there was no significant difference (P>0.05). For the observation group,the number of cases rated as excellent, good, not bad, and bad levels of cosmetic outcomes were 26, 5, and 0, respectively, and for the control group, the number was 6, 14, 6, and 0, respectively;the cosmetic outcomes of the observation group were significantly better than those of control group (P<0.05).Conclusion Nipple-areola complex sparing mastectomy and immediate breast reconstruction contribute to achieving better aesthetic and functional results, also providing a cosmetic and quality-of-life benefit for patients selected by strict preoperative selection criteria and following strict operative procedure.

Key words: Breast cancer, Nipple-areolar complex (NAC), Immediate breast reconstruction, Complications

中图分类号:

R737.9

张辉, 林孟波, 王金泗, 陈晓耕, 范跃祖, 郑敏辉. 早期乳腺癌行保留乳头乳晕全乳切除术并一期乳房重建的治疗效果[J]. 外科研究与新技术, 2018, 7(1): 4-8.

ZHANG Hui, LIN Mengbo, WANG Jinsi, CHEN Xiaogeng, FAN Yuezu, ZHENG Minhui. Clinical efficacy of nipple-sparing mastectomy and immediate breast reconstruction for early breast cancer patients[J]. Surgical Research and New Technique, 2018, 7(1): 4-8.

参考文献

[1] Lago V,Maisto V,Gimenez-Climent J,et al.Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: a 10-year follow-up study[J].Breast J,2017,23(1):1-6.
[2] Colwell AS,Tessler O,Lin AM,et al.Breast reconstruction following nipple-sparing mastectomy:predictors of compli-cations, reconstruction outcomes, and 5-year trends[J].Plast Reconstr Surg,2014,133(3):496-506.
[3] 王玮,朱丽.保留乳头乳晕复合体乳房切除术的手术切口设计[J].中国癌症杂志,2016,26(5):367-371.
[4] 李文斌,汤晗,邹洁雅,等.保留乳头乳晕的乳腺癌改良根治术治疗乳腺癌的安全性[J].国际肿瘤学杂志,2017,44(1):49-52.
[5] 孔令禹,辛智芳.保乳头乳晕全乳切除与标准改良根治术后即刻乳房重建的临床对照研究[J].中华肿瘤防治杂志,2016,23(17):1184-1188.
[6] Tzafetta K, Ahmed O, Bahia H, et al. Evaluation of the factors related to postmastectomy breast reconstruction[J].Plast Reconstr Surg,2001,107(7):1694-1701.
[7] Rossi C, Mingozzi M, Curcio A, et al. Nipple areola complex sparing mastectomy[J].Gland Surg,2015,4(6):528-540.
[8] Huang NS, Wu J. Nipple-sparing mastectomy in breast cancer:from an oncologic safety perspective[J].Chin Med J,2015,128(16):2256-2262.
[9] Colwell AS, Christensen JM.Nipple-sparing mastectomy and direct-to-implant breast reconstruction[J].Plast Reconstr Surg,2017,140(5S):44S-50S.
[10] Mota BS, Riera R, Ricci MD, et al.Nipple- and areola-sparing mastectomy for the treatment of breast cancer[J].Cochrane Database Syst Rev, 2016,1(11): 1-67.
[11] Janssen S, Holz-Sapra E, Rades D, et al.Nipple-sparing mastectomy in breast cancer patients:The role of adjuvant radiotherapy[J].Oncol Lett, 2015,9(6): 2435-2441.
[12] 蔡英,张亚男.保留乳头乳晕复合体乳房切除术后复合体坏死的研究[J].中华乳腺病杂志(电子版),2014,8(5):361-364.
[13] 张敏敏,莫军扬,覃舒婷.乳腺癌改良根治术后即刻背阔肌皮瓣乳房重建与传统改良根治术的疗[J].中国肿瘤临床,2015,42(3):157-161.
[14] 刘凤梅,龚柳燕,唐勇,等.乳腺癌改良根治术后自体背阔肌皮瓣乳房重建术后X线表现[J].放射学实践,2015,30(4):351-354.

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早期乳腺癌行保留乳头乳晕全乳切除术并一期乳房重建的治疗效果

Clinical efficacy of nipple-sparing mastectomy and immediate breast reconstruction for early breast cancer patients

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