摘要
目的研究保留乳头乳晕复合体乳房切除加一期假体植入术(NSM-IBRWI)应用于早期乳腺癌的安全性与有效性。方法 1999年6月至2006年10月,对13例患者的14只乳房实施NSM-IBRWI手术,主要采用沿乳晕上或下的180°弧形切口,完整切除乳房,保留乳头乳晕复合体,在胸大肌下或皮下植入硅凝胶假体,同时乳腺癌患者另取胸大肌外缘切口行腋窝淋巴结清扫术。结果 13例患者共植入14只假体,其中1例患者(单侧)因假体植入皮下后引流液2个月以上不减少而导致伤口无法愈合,被迫取出假体。手术成功率为92.9%(13/14)。术后6个月自我满意度良好者9例,一般者3例(其中不对称2例,疼痛1例),较差者1例(假体取出者)。13例中有原位癌1例,浸润性导管癌10例。所有患者的中位随访时间为27个月。1例患者(T1N1M0)术后9个月出现肺、骨转移,继而出现脑转移,术后15个月死亡,其余10例患者均无病生存至今。术后主要问题是伤口不愈合、不对称和疼痛。结论 NSM-IBRWI是一种安全有效治疗早期乳腺癌的新方式,它可与保乳手术取长补短。
Objective To study the effect and safety of nipple-sparing mastectomy plus immediate reconstruction with implants（NSM-IBRWI） in early breast cancer. Methods From June 1999 through October 2006 , 14 breasts of 13 patients were treated with NSM-IBRWI . 180°arc incision along the supra- or infra-areola was used, the breast was completely resected, then silicone gel prosthesis was implanted immediately, meanwhile axillary lymph node dissection was performed. Results In the 14 breasts ,the successful rate of the operation was 92.9%. A severe complication occurred in 1 （7.1% ） patient. The drainage liquid could not be reduced 2 months after implantation of the prosthesis, which resulted in nonunion of the wound, so the implant had to be removed. Two （ 14.3% ） cases presented with ischemia in the nipple-areola complex, after conservative treatment they were both healed. Six months after operation the self-satisfaction was good in 9 cases, median in 3 （ asymmetry in 2 and pain in 1 ）, and poor in 1 （the implant was removed）. Among the 13 patients, 1 had carcinoma in situ, and 10 infiltrating ductal carcinoma. Median follow-up was 27 months, showing one patient （T1N1M0 ） had lung, bone and brain metastasis 9 months after operation and died 15 months after operation. Ten patients had disease free survival and are still alive now. The main problems were non-union of wound, asymmetry and pain. Conclusion The NSM-IBRWI is oncologically safe and can be used in patients with early breast cancer
出处
《中华乳腺病杂志（电子版）》
CAS
2007年第4期92-94,共3页
Chinese Journal of Breast Disease(Electronic Edition)
