环乳晕切口联合乳腔镜腋窝淋巴结清扫在早期乳腺癌保乳手术中的应用

doi:10.3969/j.issn.1006-7795.2021.06.018

摘要/Abstract

摘要： 目的探讨经环乳晕切口联合乳腔镜腋窝淋巴结清扫实施乳腺癌保乳手术(breast conserving surgery,BCS)及腋窝淋巴结清扫的治疗效果和美容结果。方法 2016年1月至2019年1月,98例早期乳腺癌患者实施BCS,其中46例行环乳晕切口加乳腔镜腋窝淋巴结清扫术,并与同期52例经肿块表面切口联合传统腋窝淋巴结清扫的保乳手术比较,2组手术时间、术中出血、放置引流管时间、住院天数等手术观察指标;根据术后6个月以上乳房外观评价不同手术方式的乳房美容效果。结果 2组病例的肿瘤直径、肿瘤位置、肿瘤与乳头乳晕复合体(nipple-areola complex,NAC)距离、淋巴结转移、病理类型、临床分期、分子分型的比较,差异无统计学意义(P＞0.05),肿瘤表面切口组手术时间较短(P＜0.05),术中出血、放置引流管时间、住院天数比较,差异无统计学意义(P＞0.05)。美容效果比较,环乳晕切口组在质地与弹性、对称性、患侧乳房凹陷程度、皮肤颜色、手术瘢痕及乳房顺应性差值得分高于肿瘤表面切口组,差异有统计学意义(P＜0.05)。总分＞24分的优良率在环乳晕切口组(78.3%,36/46)明显高于肿瘤表面切口组(51.9%,27/52),差异有统计学意义(P＜0.05)。结论环乳晕切口切除肿瘤,能够达到与肿瘤表面切口相同的保乳治疗效果,结合乳腔镜腋窝淋巴结清扫技术,提高了早期乳腺癌保乳手术效果和患者术后生活质量,获得了最佳的美容效果。

关键词: 乳腺癌, 保乳手术, 环乳晕切口, 乳腔镜腋窝淋巴结清扫, 美容效果

Abstract: Objective To investigate the efficacy and cosmetic results of periareolar incision combined with mastoscopic axillary lymph node dissection (MALND)in breast conserving surgery (BCS)for early breast cancer. Methods From January 2016 to January 2019, 98 patients with early breast cancer received breast conserving surgery, of whom 46 cases (periareolar incision group) received periareolar incision and MALND,52 cases (tumor surface incision group)received tumor surface incision and conventional axillary lymph node dissection(CALND)in the same period.The surgical observation indicators such as the operative time,bleeding,drainage tube time,hospital stay were compared between the two groups.The cosmetic results of breast were evaluated according to the appearance of breast more than 6 months after operation. Results There was no significant difference in tumor size, tumor location, distance between tumor and nipple-areola complex(NAC), lymph node metastasis, pathological type, clinical stage and molecular type between the two groups(P>0.05). The operation time was shorter in the tumor surface incision group (P<0.05). There was no significant difference in bleeding, drainage tube time,hospital stay between the two groups (P>0.05). The scores of texture and elasticity, symmetry, degree of breast depression, skin color, surgical scar and breast compliance in the periareolar incision group were higher than those in the tumor surface incision group (P<0.05). The excellent and good rate of total score greater than 24 in the periareolar incision group (78.3%, 36/46) was significantly higher than that in the tumor surface incision group (51.9%, 27/52), the difference was significant (P<0.05). Conclusion The BCS effect is the same as that of the tumor surface incision when the tumor is removed through the periareolar incision. Combined with MALND technology, the operation effect of BCS for early breast cancer and the postoperative quality of life of patients are improved, and the best cosmetic results is obtained.

Key words: breast cancer, breast conserving surgery, periareolar incision, mastoscopic axillary lymph node dissection, cosmetic results

中图分类号:

R737.9

魏常胜, 骆成玉, 张树琦. 环乳晕切口联合乳腔镜腋窝淋巴结清扫在早期乳腺癌保乳手术中的应用[J]. 首都医科大学学报, 2021, 42(6): 1014-1020.

Wei Changsheng, Luo Chengyu, Zhang Shuqi. Application of periareolar incision combined with mastoscopic axillary lymph node dissection in breast conserving surgery for early breast cancer[J]. Journal of Capital Medical University, 2021, 42(6): 1014-1020.

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