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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 207 -212. doi: 10.3877/cma.j.issn.1674-0807.2020.04.003

所属专题： 总编推荐； 经典病例； 文献；

论著

乳腺癌皮下腺体切除联合一期植入物乳房重建59例临床分析
朱芸生1, 郑一琼1, 张艳君1, 王建东1, 王派1, 朱军永1, 冀亚霜1, 钟钰婷1, 刘梅2, 程流泉3, 李席如1,†()   
  1. 1. 100853　北京，解放军总医院第一医学中心普通外科乳腺专病中心
    2. 100853　北京，解放军总医院第一医学中心病理科
    3. 100853　北京，解放军总医院第一医学中心放射科
  • 收稿日期:2019-11-08 出版日期:2020-08-01
  • 通信作者: 李席如
  • 基金资助:
    北京市科委资助项目(D161100000816002)

Clinical analysis of 59 breast cancer patients undergoing mastectomy combined with primary implant breast reconstruction

Yunsheng Zhu1, Yiqiong Zheng1, Yanjun Zhang1, Jiandong Wang1, Pai Wang1, Junyong Zhu1, Yashuang Ji1, Yuting Zhong1, Mei Liu2, Liuquan Cheng3, Xiru Li1,†()   

  1. 1. Breast Disease Center, Department of General Surgery, General Hospital of PLA, Beijing 100853, China
    2. Department of Pathology, General Hospital of PLA, Beijing 100853, China
    3. Department of Radiology, First Medical Center, General Hospital of PLA, Beijing 100853, China
  • Received:2019-11-08 Published:2020-08-01
  • Corresponding author: Xiru Li
  • About author:
    Corresponding author: Li Xiru, Email:
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引用本文：

朱芸生, 郑一琼, 张艳君, 王建东, 王派, 朱军永, 冀亚霜, 钟钰婷, 刘梅, 程流泉, 李席如. 乳腺癌皮下腺体切除联合一期植入物乳房重建59例临床分析[J/OL]. 中华乳腺病杂志(电子版), 2020, 14(04): 207-212.

Yunsheng Zhu, Yiqiong Zheng, Yanjun Zhang, Jiandong Wang, Pai Wang, Junyong Zhu, Yashuang Ji, Yuting Zhong, Mei Liu, Liuquan Cheng, Xiru Li. Clinical analysis of 59 breast cancer patients undergoing mastectomy combined with primary implant breast reconstruction[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(04): 207-212.

目的

探讨不同乳腺癌皮下腺体切除联合一期植入物乳房重建手术方法的安全性和美容效果。

方法

回顾性分析2008年1月至2016年12月在解放军总医院第一医学中心接受皮下腺体切除联合一期植入物乳房重建的59例乳腺癌患者临床资料。59例患者采取2种分组方式：(1)根据乳房切除方式不同，分为保留乳房皮肤的皮下腺体切除术(SSM)与保留乳头、乳晕复合体的皮下腺体切除术(NSM) 2组；(2)根据乳房重建方式不同，分为"一步法"或"两步法"2组。采用秩和检验或Fisher确切概率法分别比较2组乳房切除方式和2组重建方式的并发症和美容效果。采用Kaplan-Meier法进行患者生存分析。

结果

33.9%(20/59)患者行SSM，66.1%(39/59)患者行NSM；44.1%(26/59)患者行"一步法"重建，55.9%(33/59)患者行"两步法"重建。30.5%(18/59)患者同时行对侧乳腺预防性皮下腺体切除术加植入物重建术。中位随访71个月(范围：27～133个月)，失访12例。随访的47例患者中术后假体移位发生率为10.6%(5/47)，包膜挛缩和假体破裂发生率均为4.3%(2/47)。21.3%(10/47)患者最终取出植入物。不同乳房切除方式的并发症发生率和植入物取出率差异无统计学意义(P＝0.697、0.716)；不同重建方式的并发症发生率和植入物取出率差异无统计学意义(P＝0.449、1.000)。死亡2例，余45例患者术后美容效果评分的优良率为73.3%(33/45)，不同乳房切除方式和不同重建方式的术后美容效果评分比较差异无统计学意义(P＝0.296、1.000)。患者是否同时行对侧预防性皮下腺体切除及植入物重建术的美容效果评分比较差异也无统计学意义(P＝0.571)。患者的OS率为95.7%(45/47)，DFS率为89.4%(42/47)。

结论

乳腺癌皮下腺体切除联合一期植入物乳房重建术后总体生存情况良好，不管采用哪种乳房切除方式或重建方式，术后不良事件与并发症发生率均较低，可达到预期的临床疗效，并获得良好的美容效果。

关键词: 乳腺肿瘤, 乳房成形术, 安全性
Objective

To investigate the safety and cosmetic effect of mastectomy combined with primary implant breast reconstruction for breast cancer patients.

Methods

The clinical data of 59 breast cancer patients who underwent mastectomy combined with primary implant breast reconstruction in the General Hospital of PLA from Janurary 2008 to December 2016 were retrospectively analyzed. All patients were divided into two groups: skin-sparing mastectomy (SSM) group and nipple-sparing mastectomy (NSM) group (sparing the nipple-areola complex) or according to the different methods of breast reconstruction, they were divided into one-step reconstruction group and two-step reconstruction group. The rank sum test or Fisher exact test was used to compare the complications and cosmetic effect between SSM group and NSM group, or between one-step reconstruction group and two-step reconstruction group. The Kaplan-Meier method was used for survival analysis.

Results

In all cases, 33.9% (20/59) of the patients underwent SSM and 66.1% (39/59) underwent NSM; 44.1% (26/59) underwent one-step breast reconstruction and 55.9% (33/59) underwent two-step breast reconstruction. Totally 30.5% (18/59) of cases underwent contralateral prophylactic mastectomy plus implant reconstruction at the same time. The median follow-up was 71 months (range: 27-133 months), and 12 cases were missing in the follow-up. The incidence of postoperative prosthesis displacement was 10.6% (5/47), and the incidence of capsular contracture and prosthesis rupture were both 4.3% (2/47). The implants were removed in 21.3% of the patients (10/47). The complication rate and incidence of implant removal presented no significant difference between SSM group and NSM group (P=0.697, 0.716), or between one-step reconstruction group and two-step reconstruction (P= 0.449, 1.000). The proportion of patients with excellent and good cosmetic scores was 73.3% (33/45), indicating no significant difference between SSM group and NSM group, or between one-step reconstruction group and two-step reconstruction (P=0.296, 1.000). There was no significant difference in the cosmetic scores between patients with contralateral prophylactic mastectomy plus implant reconstruction and patients without (P=0.571). The OS of all patients was 95.7% (45/47), and the DFS was 89.4% (42/47).

Conclusion

The mastectomy combined with primary implant breast reconstruction yeilds excellent overall survival, low incidences of adverse events or complications and good cosmetic effect in breast cancer patients whether they receive SSM or NSM, one-step or two-step breast reconstruction.

Key words: Breast neoplasms, Mammaplasty, Safety
表1 59例乳腺癌皮下腺体切除联合一期植入物乳房重建患者的临床病理特征(例)
临床病理特征 乳房切除方式 检验值 P值 乳房重建方式 检验值 P值
SSM(n＝20) NSM(n＝39) 一步法(n＝26) 两步法(n＝33)
年龄(岁)                
  <35 5 10 -0.280 0.780a 6 9 -0.482 0.630a
  35～45 11 23 15 19
  >45 4 6 5 5
BMI                
  <18.5 0 5 -1.039 0.299a 3 2 -0.349 0.727a
  18.5～24.9 18 30 19 29
  >24.9 2 4 4 2
肿瘤直径(cm)                
  <1.0 3 4 -0.888 0.375a 3 4 -1.065 0.287a
  1.0～2.0 8 24 12 20
  2.1～3.0 4 6 5 5
  >3.0 5 5 6 4
病理诊断                
  原位癌 8 10 1.286 0.257b 11 7 3.053 0.087b
  浸润性癌 12 29 15 26
病理分期                
  0/Ⅰ期 9 15 0.234 0.628b 10 14 0.095 0.758b
  Ⅱ期 11 24 16 19
ER                
  阴性 4 7   1.000c 5 6   0.085c
  阳性 12 25 13 24
  未知 4 7 8 3
PR                
  阴性 4 6   0.855c 4 6   0.103c
  阳性 12 26 14 24
  未知 4 7 8 3
表2 47例皮下腺体切除联合一期植入物乳房重建患者术后并发症和植入物取出情况
手术方式 例数 并发症 植入物取出
例(%) P值 例(%) P值
乳房切除方式          
  SSM 16 2(2/16a) 0.697b 4(4/16a) 0.716b
  NSM 31 7(22.6) 6(19.4)
重建方式          
  一步法 18 3(3/18a) 1.000b 4(4/18a) 1.000b
  两步法 29 6(20.7) 6(20.7)
表3 45例皮下腺体切除联合一期植入物乳房重建患者术后美容效果评价
手术方式 例数 美容效果 P值
优/良[例(%)] 尚可/差[例(%)]
乳房切除方式        
  SSM 16 10(10/16a) 6(6/16a) 0.296b
  NSM 29 23(79.3) 6(20.7)
乳房重建方式        
  一步法 17 13(13/17a) 4(4/17a) 1.000b
  两步法 28 20(71.4) 8(28.6)
预防性切除        
  是 16 12(12/16a) 4(4/16a) 0.571b
  否 29 21(72.4) 8(27.6)
图1 47例乳腺癌皮下腺体切除联合一期植入物乳房重建患者术后无瘤生存曲线
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