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。

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.