中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (11): 1263-1268.DOI: 10.19538/j.cjps.issn1005-2208.2024.11.15

• 论著 • 上一篇    下一篇

逆序腔镜和传统开放双乳腺体切除联合全胸肌后假体乳房重建术疗效对比研究

张    晴，谢妍妍，梁法清，邬    昊，朱中建，杜正贵   

  1. 四川大学华西医院普通外科   乳腺疾病中心，四川成都 610041
  • 出版日期:2024-11-01 发布日期:2024-11-26

  • Online:2024-11-01 Published:2024-11-26

摘要： 目的    比较逆序腔镜和传统开放双乳腺体切除联合全胸肌后假体乳房重建在外科学安全性、美容学效果及肿瘤学安全性方面的差异。方法    回顾性分析2017-01-01—2022-04-30于四川大学华西医院乳腺疾病中心行双乳腺体切除联合全胸肌后假体乳房重建手术76例病人的临床资料。所有病人按手术方式分为逆序腔镜组（39例）和传统开放组（37例）。收集并比较两组基线资料、术中资料及术后并发症发生情况，多因素logistic回归分析发生外科学并发症及术后病人对切口不满意的影响因素。结果    两组手术时间差异无统计学意义［逆序腔镜组（314.7±91.8）min vs. 传统开放组（278.5±95.8）min，P=0.097］。与传统开放组相比，逆序腔镜组随访时间更短［76（37，90）个月 vs. 38（27，51）个月］，任何外科学并发症的发生率更低（63.9% vs. 10.3%），Scar-Q评分结果更高［（34.0±8.4）分 vs. （81.2±10.9）分］，Hurris量表、Ueda量表结果更高，差异均有统计学意义（P＜0.05）。多因素logistic回归分析结果显示，逆序腔镜手术是术后发生外科学并发症的独立保护因素（OR=0.07，95%CI 0.01~0.42，P=0.003），是术后病人对切口不满意的独立保护因素（OR=0.06，95%CI 0.01~0.28，P=0.001）。逆序腔镜组有1例病人术后6个月出现胸壁、腋窝及锁骨上局部复发，传统开放组有1例病人术后14个月出现骨转移，两组24个月无病生存率差异无统计学意义（98.7% vs. 97.5%，P=0.648）。结论    逆序腔镜双乳腺体切除联合全胸肌后假体乳房重建术与传统传统开放手术相比，并发症发生率显著降低，美容学效果显著改善，具备广阔的应用前景。

关键词: 乳房切除术, 逆序腔镜, 传统开放, 双侧假体重建, 全胸肌后重建

Abstract: To compare the surgical safety, cosmetic effect, and oncological safety between reverse endoscopic (R-E) and conventional open (C-O) bilateral mastectomy with total subpectoral implant-based reconstruction (IBR). Methods    Clinical data of 76 patients who underwent bilateral mastectomy with total subpectoral IBR at Breast Center, West China Hospital, Sichuan University from January 1, 2017, to April 30, 2019, were retrospectively analyzed. According to the operation method, they were divided into the R-E group (39 patients) and the C-O group (37 patients). The baseline data, intraoperative data, and postoperative complications were collected and compared between the two groups. Multivariate logistic regression analysis was used to analyze the influencing factors of surgical complications and postoperative patient satisfaction with the incision. Results    There was no significant difference in operation time between the two groups ［(314.7±91.8) min vs. (278.5±95.8) min, P=0.097］. Compared with the C-O group, the R-E group had a shorter follow-up time ［76(37,90) months vs. 38(27,51) months］ and a lower incidence of any surgical complications (63.9% vs. 10.3%). Besides, the scores of Scar-Q ［(34.0±8.4) vs. (81.2±10.9)］, Hurris and Ueda were higher , and the differences were statistically significant (P< 0.05). Multivariate logistic regression analysis showed that R-E surgery was an independent protective factor for postoperative surgical complications (OR=0.07, 95%CI 0.01-0.42, P=0.003) and an independent protective factor for postoperative patient dissatisfaction with the incision (OR=0.06, 95%CI 0.01-0.28，P=0.001). Local recurrence of the chest wall, axilla and supraclavicular region occurred in 1 patient in the R-E group at 6 months after operation, and 1 patient in the traditional open group had bone metastasis at 14 months after operation. There was no significant difference in the 24-month disease-free survival rate between the two groups (98.7% vs. 97.5%, P=0.648). Conclusion    The innovative R-E bilateral mastectomy with total subpectoral IBR significantly reduced the incidence of complications compared with C-O surgery, and the cosmetic effect is improved dramatically, which has broad application prospects.

Key words: breast surgery, reverse sequence endoscopic surgery, conventional open surgery, bilateral implant-based breast reconstruction, total subpectoral reconstruction