中国实用外科杂志

中国实用外科杂志

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保留乳头乳晕的乳房切除术联合DIEP即刻乳房重建临床效果分析

储呈玉1，金贻婷1，张    薇1，王红鹰1，董佳生2，徐    华2，邹    强1   

  1. 1 复旦大学附属华山医院甲乳外科  华山东方乳房专科医院，上海 200050；2上海交通大学医学院附属第九人民医院整复外科，上海 200011
  • 出版日期:2019-11-01 发布日期:2019-11-12

  • Online:2019-11-01 Published:2019-11-12

摘要：

目的    分析总结保留乳头乳晕的乳房切除术联合腹壁下深动脉穿支皮瓣（DIEP）即刻乳房重建的临床效果和操作经验。 方法    回顾性分析复旦大学附属华山医院甲乳外科2016年1月至2018年10月行全乳切除联合DIEP即刻乳房重建81例临床资料，比较在联合DIEP即刻重建时，保留乳头乳晕（NSM组，38例）和未保留乳头乳晕（非NSM组，43例）的全乳切除两种不同术式的手术成功率、安全性、并发症、病人满意度等。 结果    81例DIEP均存活，无皮瓣丢失。未出现乳房皮肤坏死、术区感染、皮下积液。NSM组分别有1例（2.6%）血管危象和2例（5.3%）部分脂肪坏死，非NSM组分别有2例（4.7%）血管危象和2例（4.7%）部分脂肪坏死，组间差异无统计学意义（P>0.05）。NSM组NAC血运障碍3例（7.9%），未出现完全坏死。术后6个月，NSM组满意率81.6%，高于非NSM组（72.1%），但两组差异无统计学意义（P=0.315）。中位随访时间22（8～42）个月，无局部复发和远处转移。结论    在准确把握手术指征及掌握手术技巧的前提下，NSM联合DIEP即刻乳房重建安全可靠，较不保留乳头乳晕的手术，不增加并发症，NAC坏死率可控，病人满意度高。

关键词: 保留乳头乳晕的乳房切除术, 即刻乳房重建, 腹壁下深动脉穿支皮瓣

Abstract:

Clinical results of autologous reconstruction with DIEP flap following nipple-sparing mastectomy        CHU Cheng-yu*, JIN Yi-ting*, ZHANG Wei, et al. *Department of Thyroid and Breast Surgery, Huashan Hospital, Fudan University, Shanghai 200050, China
Corresponding authors: ZOU Qiang, E-mail: zouqiang003@aliyun.com; XU Hua, E-mail: doctorxuhua@hotmail.com
        CHU Cheng-yu and  JIN Yi-ting are the first authors who contributed equally to the article
Abstract    Objective    To analyze the clinical results of autologous reconstruction with DIEP flap following nipple-sparing mastectomy and summarize experience. Methods    From January 2016 to October 2018, DIEP flaps were utilized in 81 surgical cases of immediate breast reconstruction after mastectomy in Huashan Hospital of Fudan University. Success rate, safety, complications and patient satisfaction of nipple-sparing mastectomy（NSM）group (38 cases) and non-NSM（NNSM）group (43 cases) were compared. Results    All DIEP flaps in 81 cases were successful with a flap survival rate of 100%. No skin necrosis, infection, or seroma occurred. There were 1 case（2.6%）of vascular complication and 2 cases（5.3%）of partial fat necrosis in NSM group, and 2 cases（4.7%） of vascular complication and 2 cases（4.7%） of partial fat necrosis in non-NSM group. No statistically significant difference was found between groups. Three cases of partial NAC ischemia （7.9%） happened in NSM group with no complete necrosis. There was a greater satisfaction in NSM group（81.6%）than non-NSM group（72.1%） on the overall impression of breast reconstruction in 6 months after surgeries，but the difference was not significant（P=0.315）. Over a median follow-up period of 22 months, no local recurrence or distant metastasis were observed. Conclusion    Autologous reconstruction with DIEP flap following nipple-sparing mastectomy is safe and reliable for carefully selected patients when operations are executed with proficient operative skills. Complications are similar in the approach compared with DIEP flap immediate breast reconstruction following non-NSM. The technique has a controllable rate of NAC necrosis and offers the advantage of cosmetic effect.

Key words: nipple-sparing mastectomy, immediate breast reconstruction, deep inferior epigastric artery perforator flap