保留皮膚的乳腺癌切除術后乳房重建療效觀察_《中國修復重建外科雜志》

作者：

陳潔 , 呂青 , 王曉東 , 李宏江 , 陳玉娟 , 羊曉勤 , 曾荷琳

四川大學華西醫院甲狀腺乳腺外科（成都，610041）;

關鍵詞：

乳腺癌乳腺切除乳房重建假體擴張器

DOI：

10.7507/1002-1892.20130191

視頻：

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目的探討對于不具備保乳條件的乳腺癌患者，采用保留乳房皮膚乳腺切除術（skin-sparing mastectomy，SSM）或保留乳頭乳暈乳腺切除術（nipple-sparing mastectomy，NSM）聯合乳房重建的方法及療效。方法2005年10月－2011年7月，收治89例不具備保乳條件的乳腺癌女性患者。年齡19～55歲，平均42.4 歲。病程1～24個月，平均5.7個月。病理診斷：浸潤性癌55例，導管內癌（ductal carcinoma in situ，DCIS）15例，浸潤性導管癌+ DCIS 8例，DCIS伴浸潤10例，隱匿性乳腺癌1例。根據美國腫瘤聯合會（AJCC）腫瘤分期標準：0期15例，Ⅰ期51例，Ⅱ期22例，分期不明1例。根據腫塊大小、位置及乳頭是否浸潤等，33例行SSM，56例行NSM；其中9例前哨淋巴結陽性及1例隱匿性乳腺癌患者行一期腋窩淋巴結清掃聯合擴張器植入，二期行乳房重建；其余患者均一期乳房重建。術后按美國國立綜合癌癥網（NCCN）指南進行放、化療。結果術后共5例發生并發癥，均為NSM聯合假體植入患者，其中創腔出血1例，感染2例，局部皮膚壞死2例；其余患者切口均Ⅰ期愈合，NSM患者保留乳頭均無壞死發生。患者術后均獲隨訪，隨訪時間14～88個月，中位隨訪時間40個月。乳房重建術后10個月評定重建乳房美容效果，獲優40例，良33例，中14例，差2例，優良率為82%。患者對乳房外觀滿意；隨訪期內均無復發和轉移。結論對于不具備保乳條件的乳腺癌患者，采用SSM或NSM聯合乳房重建治療，能使在不增加乳腺癌復發和轉移風險的同時，獲較滿意的乳房外形。

引用本文： 陳潔,呂青,王曉東,李宏江,陳玉娟,羊曉勤,曾荷琳. 保留皮膚的乳腺癌切除術后乳房重建療效觀察. 中國修復重建外科雜志, 2013, 27(7): 872-875. doi: 10.7507/1002-1892.20130191 復制

1.	Pérez-San-Gregorio MA, Fernández-Jiménez E, Martín-Rodríguez A, et al. Quality of life in women following various surgeries of body manipulation: Organ transplantation, mastectomy, and breast reconstruction. J Clin Psychol Med Settings, 2013. [Epub ahead of print].
2.	Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol, 2012, 13(4): 412-419.
3.	張保寧. 早期乳腺癌保留乳房手術的回顧與展望. 中華乳腺病雜志(電子版), 2010, 4(3): 238-242.
4.	Carlson GW. Technical advances in skin sparing mastectomy. Int J Surg Oncol, 2011, (2011): 396901.
5.	Ananthakrishnan P, Feldman S. Nipple-sparing mastectomy: indications, oncologic safety. Minerva Chir, 2012, 67(3): 257-270.
6.	Yi M, Mittendorf EA, Cormier JN, et al. Novel staging system for predicting disease-specific survival in patients with breast cancer treated with surgery as the first intervention: time to modify the current American Joint Committee on Cancer staging system. J Clin Oncol, 2011, 29(35): 4654-4661.
7.	NCCN org. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Breast Cancer. [2012-01-20]. http://www.nccn.com/cancer-guidelines. html.
8.	Mallon P, Feron JG, Couturaud B, et al. The role of nipple-sparing mastectomy in breast cancer: a comprehensive review of the literature. Plast Reconstr Surg, 2013, 11(5): 969-984.
9.	Rath MG, Heil J, Domschke C, et al. Predictors of resectability in breast-conserving therapy. Arch Gynecol Obstet, 2012, 286(4): 1023-1031.
10.	Kinoshita S, Nojima K, Takeishi M, et al. Retrospective comparison of non-skin-sparing mastectomy and skin-sparing mastectomy with immediate breast reconstruction. Int J Surg Oncol, 2011, (2011): 876520.
11.	Romics L Jr, Stallard S, Weiler-Mithoff E. Oncologic safety of skin-sparing mastectomy followed by immediate breast reconstruction: rate and localization of recurrences, and impact of reconstruction techniques. Orv Hetil, 2013, 154(5): 163-171.
12.	Romics L Jr, Chew BK, Weiler-Mithoff E, et al. Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg, 2012, 99(6): 799-706.
13.	Serra R, Miglietta AM, Abonante S, et al. Skin-sparing mastectomy with immediate breast and nipple reconstruction: a new technique of nipple reconstruction. J Clin Oncol, 2011, 29(35): 4654-4661.
14.	van Deventer PV, Page BJ, Graewe FR. Vascular anatomy of the breast and nipple-areola complex. Plast Reconstr Surg, 2008, 121(5): 1860-1861.
15.	Harness JK, Vetter TS, Salibian AH. Areola and nipple-areola-sparing mastectomy for breast cancer treatment and risk reduction: report of an initial experience in a community hospital setting. Ann Surg Oncol, 2011, 18(4): 917-922.
16.	Meretoja TJ, Rasia S, von Smitten KA, et al. Late results of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg, 2007, 94(10): 1220-1225.
17.	Chung AP, Sacchini V. Nipple-sparing mastectomy: where are we now? Surg Oncol, 2008, 17(4): 261-266.
18.	Muntan CD, Sundine MJ, Rink RD, et al. Inframammary fold: a histologic reappraisal. Reconstr Surg, 2000, 105(2): 549-556.
19.	Agrawal A, Sibbering DM, Courtney CA. Skin sparing mastectomy and immediate breast reconstruction: a review. Eur J Surg Oncol, 2013, 39(4): 320-328.
20.	Nava M, Quattrone P, Riggio E. Focus on the breast fascial system: a new approach for inframammary fold reconstruction. Plast Reconstr Surg, 1998, 102(4):1034-1045.
21.	Loustau HD, Mayer HF, Sarrabayrouse M. Immediate prosthetic breast reconstruction: the ensured subpectoral pocket (ESP). J Plast Reconstr Aesthet Surg, 2007, 60(11): 1233-1238.

1. Pérez-San-Gregorio MA, Fernández-Jiménez E, Martín-Rodríguez A, et al. Quality of life in women following various surgeries of body manipulation: Organ transplantation, mastectomy, and breast reconstruction. J Clin Psychol Med Settings, 2013. [Epub ahead of print].
2. Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol, 2012, 13(4): 412-419.
3. 張保寧. 早期乳腺癌保留乳房手術的回顧與展望. 中華乳腺病雜志(電子版), 2010, 4(3): 238-242.
4. Carlson GW. Technical advances in skin sparing mastectomy. Int J Surg Oncol, 2011, (2011): 396901.
5. Ananthakrishnan P, Feldman S. Nipple-sparing mastectomy: indications, oncologic safety. Minerva Chir, 2012, 67(3): 257-270.
6. Yi M, Mittendorf EA, Cormier JN, et al. Novel staging system for predicting disease-specific survival in patients with breast cancer treated with surgery as the first intervention: time to modify the current American Joint Committee on Cancer staging system. J Clin Oncol, 2011, 29(35): 4654-4661.
7. NCCN org. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Breast Cancer. [2012-01-20]. http://www.nccn.com/cancer-guidelines. html.
8. Mallon P, Feron JG, Couturaud B, et al. The role of nipple-sparing mastectomy in breast cancer: a comprehensive review of the literature. Plast Reconstr Surg, 2013, 11(5): 969-984.
9. Rath MG, Heil J, Domschke C, et al. Predictors of resectability in breast-conserving therapy. Arch Gynecol Obstet, 2012, 286(4): 1023-1031.
10. Kinoshita S, Nojima K, Takeishi M, et al. Retrospective comparison of non-skin-sparing mastectomy and skin-sparing mastectomy with immediate breast reconstruction. Int J Surg Oncol, 2011, (2011): 876520.
11. Romics L Jr, Stallard S, Weiler-Mithoff E. Oncologic safety of skin-sparing mastectomy followed by immediate breast reconstruction: rate and localization of recurrences, and impact of reconstruction techniques. Orv Hetil, 2013, 154(5): 163-171.
12. Romics L Jr, Chew BK, Weiler-Mithoff E, et al. Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg, 2012, 99(6): 799-706.
13. Serra R, Miglietta AM, Abonante S, et al. Skin-sparing mastectomy with immediate breast and nipple reconstruction: a new technique of nipple reconstruction. J Clin Oncol, 2011, 29(35): 4654-4661.
14. van Deventer PV, Page BJ, Graewe FR. Vascular anatomy of the breast and nipple-areola complex. Plast Reconstr Surg, 2008, 121(5): 1860-1861.
15. Harness JK, Vetter TS, Salibian AH. Areola and nipple-areola-sparing mastectomy for breast cancer treatment and risk reduction: report of an initial experience in a community hospital setting. Ann Surg Oncol, 2011, 18(4): 917-922.
16. Meretoja TJ, Rasia S, von Smitten KA, et al. Late results of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg, 2007, 94(10): 1220-1225.
17. Chung AP, Sacchini V. Nipple-sparing mastectomy: where are we now? Surg Oncol, 2008, 17(4): 261-266.
18. Muntan CD, Sundine MJ, Rink RD, et al. Inframammary fold: a histologic reappraisal. Reconstr Surg, 2000, 105(2): 549-556.
19. Agrawal A, Sibbering DM, Courtney CA. Skin sparing mastectomy and immediate breast reconstruction: a review. Eur J Surg Oncol, 2013, 39(4): 320-328.
20. Nava M, Quattrone P, Riggio E. Focus on the breast fascial system: a new approach for inframammary fold reconstruction. Plast Reconstr Surg, 1998, 102(4):1034-1045.
21. Loustau HD, Mayer HF, Sarrabayrouse M. Immediate prosthetic breast reconstruction: the ensured subpectoral pocket (ESP). J Plast Reconstr Aesthet Surg, 2007, 60(11): 1233-1238.

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