保留乳头乳晕的乳腺癌改良根治术疗效分析
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摘要
目的分析保留乳头乳晕的乳腺癌改良根治术(NSM)的临床可行性与安全性。方法选择将2017年8月至2018年8月我院乳腺外科收治的76例早期乳腺癌患者,根据手术方法的不同分为NSM组36例(NSM治疗)和传统组40例(传统乳腺癌改良根治术治疗)。记录2组患者手术完成情况,术后至少随访12个月,统计局部复发、远处转移情况及并发症发生情况,并于术后12个月进行乳房美容学与生活质量评价。结果 NSM组手术时间、出血量、清扫淋巴结个数、引流量及术后住院时间与传统组比较,差异无统计学意义(P> 0. 05),术后1年局部复发率、远处转移率及术后术区感染、皮下积液、脂肪液化、皮瓣局部坏死、上肢水肿等并发症发生率与传统组比较,差异无统计学意义(P> 0. 05)。但NSM组术后1年乳房美容学评价优良率明显高于传统组,美国专门针对乳腺癌治疗功能评价系统量表体系共性模块(FACT-G)量化评分中生理状况、社会家庭状况、情感状况、功能状况评分及总分均高于传统组,差异均有统计学意义(P <0. 05)。结论 NSM可取得与传统乳腺癌改良根治术类似的治疗效果,未增加并发症风险,且患者可获得更好的乳房美容学效果与生存质量。
Objective To analyze the clinical feasibility and safety of modified nipple-sparing radical mastectomy( NSM) for breast cancer. Methods Totally 76 patients with early breast cancer who were admitted to our hospital from August 2017 to August 2018 were divided into the NSM group( 36 cases,treated with NSM) and the traditional group( 40 cases,treated with traditional radical mastectomy) according to different treatment methods. The completion of surgery was recorded. All the patients were followed up for at least 12 months after surgery. The occurrence of local recurrence,distant metastasis and complications were statistically analyzed. The breast cosmetology and quality of life were evaluated at 12 months after surgery. Results There was no significant difference in surgical time,blood loss,number of removed lymph nodes,drainage volume,postoperative hospital stay between the two groups( P > 0. 05). At 1 year after surgery,there was no significant difference in local recurrence rate,distant metastasis rate or the incidence of postoperative complications such as surgical site infection,subcutaneous effusion,fat liquefaction,local necrosis of flaps and upper limb edema between the two groups( P > 0. 05). However,the excellent and good rate of breast cosmetic evaluation in NSM group was significantly higher than that in the traditional group. The scores of physiological status,social and family status,emotional status and functional status and the total score of Functional Assessment of Cancer TherapyGeneral( FACT-G) were also higher than those of the traditional group( P < 0. 05). Conclusion NSM can achieve good therapeutic effects similar with traditional radical mastectomy,without increasing the risk of complications. What's more,patients can obtain better breast cosmetology and quality of life through modified nipple-sparing radical mastectomy.
Objective To analyze the clinical feasibility and safety of modified nipple-sparing radical mastectomy( NSM) for breast cancer. Methods Totally 76 patients with early breast cancer who were admitted to our hospital from August 2017 to August 2018 were divided into the NSM group( 36 cases,treated with NSM) and the traditional group( 40 cases,treated with traditional radical mastectomy) according to different treatment methods. The completion of surgery was recorded. All the patients were followed up for at least 12 months after surgery. The occurrence of local recurrence,distant metastasis and complications were statistically analyzed. The breast cosmetology and quality of life were evaluated at 12 months after surgery. Results There was no significant difference in surgical time,blood loss,number of removed lymph nodes,drainage volume,postoperative hospital stay between the two groups( P > 0. 05). At 1 year after surgery,there was no significant difference in local recurrence rate,distant metastasis rate or the incidence of postoperative complications such as surgical site infection,subcutaneous effusion,fat liquefaction,local necrosis of flaps and upper limb edema between the two groups( P > 0. 05). However,the excellent and good rate of breast cosmetic evaluation in NSM group was significantly higher than that in the traditional group. The scores of physiological status,social and family status,emotional status and functional status and the total score of Functional Assessment of Cancer TherapyGeneral( FACT-G) were also higher than those of the traditional group( P < 0. 05). Conclusion NSM can achieve good therapeutic effects similar with traditional radical mastectomy,without increasing the risk of complications. What's more,patients can obtain better breast cosmetology and quality of life through modified nipple-sparing radical mastectomy.
引文
[1]邵志平,胡孝渠,李继承,等.保留乳头乳晕的乳腺癌改良根治术与传统根治术对比[J].中国妇幼保健,2015,30(12):1946-1948.doi:10.7620/zgfybj.j.issn.1001-4411.2015.12.54.
[2]Jensen JA.Nipple-sparing mastectomy[J].J Am Coll Surg,2018,226(1):108.doi:10.1016/j.jamcollsurg.2017.11.001.
[3]Reitsamer R,Peintinger F.Prepectoral implant placement and complete coverage with porcine acellular dermal matrix:a new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy[J].J Plast Reconstr Aesthet Surg,2015,68(2):162-167.doi:10.1016/j.bjps.2014.10.012.
[4]王永南,张安秦.保留乳头乳晕的乳腺癌改良根治术的术后并发症[J].国际外科学杂志,2016,43(3):201-205.doi:10.3760/cma.j.issn.1673-4203.2016.03.018.
[5]共识专家讨论组.保留乳头乳晕复合体乳房切除术的专家共识与争议(2015年版)[J].中国癌症杂志,2016,26(5):476-479.doi:10.3969/j.issn.1007-3969.2016.05.022.
[6]崔智淼,骆成玉,杨齐,等.乳腔镜辅助保留乳头乳晕复合体改良根治术治疗早期乳腺癌的临床研究[J].北京医学,2018,40(1):34-37.doi:10.15932/j.0253-9713.2018.01.011.
[7]Cruz LDL,Moody AM,Tappy EE,et al.Overall survival,disease-free survival,local recurrence,and nipple-areolar recurrence in the setting of nipple-sparing mastectomy:a meta-analysis and systematic review[J].Ann Surg Oncol,2015,22(10):3241-3249.doi:10.1245/s10434-015-4739-1.
[8]谭飞.保留乳头乳晕的乳腺癌改良根治术与传统根治术对比[J].中华全科医学,2013,11(7):1067-1069.doi:10.7620/zgfybj.j.issn.1001-4411.2015.12.54.
[9]Brucker PS,Yost K,Cashy J,et al.General population and cancer patient norms for the functional assessment of cancer therapy-general(FACT-G)[J].Eval Health Prof,2005,28(2):192.doi:10.1177/0163278705275341.
[10]王萌萌,王京,华建芬,等.保留乳头乳晕的乳腺癌改良根治术联合Ⅰ期假体植入与传统乳腺癌改良根治术的临床疗效对比[J].中国妇幼保健,2017,32(23):6040-6043.doi:10.7620/zgfybj.j.issn.1001-4411.2017.23.83.
[11]Tang R,Coopey SB,Colwell AS,et al.Nipple-sparing mastectomy in irradiated breasts:selecting patients to minimize complications[J].Ann Surg Oncol,2015,22(10):3331-3337.doi:10.1245/s10434-015-4669-y.
[12]鲁长存,陈俊国,王阁,等.不同术式联合调强放疗对乳腺癌患者生命质量和性生活的影响[J].局解手术学杂志,2017,26(4):267-270.doi:10.11659/jjssx.11E016047.
[13]Orzalesi L,Casella D,Santi C,et al.Nipple sparing mastectomy:Surgical and oncological outcomes from a national multicentric registry with913 patients(1006 cases)over a six year period[J].Breast,2016,25:75-81.doi:10.1016/j.breast.2015.10.010.
[14]Davila AA,Mioton LM,Chow G,et al.Immediate two-stage tissue expander breast reconstruction compared with one-stage permanent implant breast reconstruction:a multi-institutional comparison of shortterm complications[J].J Plast Surg Hand Surg,2013,47(5):344-349.doi:10.3109/2000656X.2013.767202.
[15]Manning AT,Wood C,Eaton A,et al.Nipple-sparing mastectomy in patients with BRCA 1/2 mutations and variants of uncertain significance[J].Br J Surg,2015,102(11):1354-1359.doi:10.1002/bjs.9884.
[16]文斌.保留乳头乳晕的乳腺癌改良根治术治疗乳腺癌的安全性[J].国际肿瘤学杂志,2017,44(1):49-52.doi:10.3760/cma.j.issn.1673-422X.2017.01.013.
[17]Chirappapha,Prakasit,Petit,et al.Nipple sparing mastectomy:does breast morphological factor related to necrotic complications?[J].Plast Reconstr Surg Glob Open,2016,2(1):e99.doi:10.1097/GOX.0000000000000038.
[18]王常珺,姚儒,周易冬,等.单切口环乳晕入路保留乳头乳晕乳腺癌改良根治术联合同期乳腺扩张器植入术的应用分析[J].中华内分泌外科杂志,2017,11(2):92-96.doi:10.3760/cma.j.issn.1674-6090.2017.02.002.
[19]刘梦友,金功圣,陈晨,等.保留乳头乳晕乳腺癌改良根治术后即刻扩展型背阔肌乳房再造术的临床应用[J].中国普通外科杂志,2018,27(5):601-607.doi:10.3978/j.issn.1005-6947.2018.05.012.
[20]Frederick MJ,Lin AM,Neuman R,et al.Nipple-sparing mastectomy in patients with previous breast surgery:comparative analysis of 775 immediate breast reconstructions[J].Plast Reconstr Surg,2016,27(1):55-57.doi:10.1097/PRS.0000000000001283.
[21]Moo TA,Pinchinat T,Mays S,et al.Oncologic outcomes after nipplesparing mastectomy[J].Ann Surg Oncol,2016,23(10):1-5.doi:10.1245/s10434-016-5366-1.
[22]刘学敏,顾瑞香,王海强,等.保留乳头乳晕复合体的乳腺癌术后即刻乳房重建术[J].中国美容整形外科杂志,2016,27(4):212-214.doi:10.3969/j.issn.1673-7040.2016.04.007.
[23]孙萍,梁栋.保留乳头乳晕改良根治术联合假体置入术对早中期乳腺癌患者免疫功能及负性情绪的影响[J].中国临床医生杂志,2018,46(4):453-456.doi:10.3969/j.issn.2095-8552.2018.04.026.
[24]Folli S,Mingozzi M,Curcio A,et al.Nipple-sparing mastectomy:an alternative technique for large ptotic breasts[J].J Am Coll Surg,2015,220(5):e65-e69.doi:10.1016/j.jamcollsurg.2015.01.028.
[2]Jensen JA.Nipple-sparing mastectomy[J].J Am Coll Surg,2018,226(1):108.doi:10.1016/j.jamcollsurg.2017.11.001.
[3]Reitsamer R,Peintinger F.Prepectoral implant placement and complete coverage with porcine acellular dermal matrix:a new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy[J].J Plast Reconstr Aesthet Surg,2015,68(2):162-167.doi:10.1016/j.bjps.2014.10.012.
[4]王永南,张安秦.保留乳头乳晕的乳腺癌改良根治术的术后并发症[J].国际外科学杂志,2016,43(3):201-205.doi:10.3760/cma.j.issn.1673-4203.2016.03.018.
[5]共识专家讨论组.保留乳头乳晕复合体乳房切除术的专家共识与争议(2015年版)[J].中国癌症杂志,2016,26(5):476-479.doi:10.3969/j.issn.1007-3969.2016.05.022.
[6]崔智淼,骆成玉,杨齐,等.乳腔镜辅助保留乳头乳晕复合体改良根治术治疗早期乳腺癌的临床研究[J].北京医学,2018,40(1):34-37.doi:10.15932/j.0253-9713.2018.01.011.
[7]Cruz LDL,Moody AM,Tappy EE,et al.Overall survival,disease-free survival,local recurrence,and nipple-areolar recurrence in the setting of nipple-sparing mastectomy:a meta-analysis and systematic review[J].Ann Surg Oncol,2015,22(10):3241-3249.doi:10.1245/s10434-015-4739-1.
[8]谭飞.保留乳头乳晕的乳腺癌改良根治术与传统根治术对比[J].中华全科医学,2013,11(7):1067-1069.doi:10.7620/zgfybj.j.issn.1001-4411.2015.12.54.
[9]Brucker PS,Yost K,Cashy J,et al.General population and cancer patient norms for the functional assessment of cancer therapy-general(FACT-G)[J].Eval Health Prof,2005,28(2):192.doi:10.1177/0163278705275341.
[10]王萌萌,王京,华建芬,等.保留乳头乳晕的乳腺癌改良根治术联合Ⅰ期假体植入与传统乳腺癌改良根治术的临床疗效对比[J].中国妇幼保健,2017,32(23):6040-6043.doi:10.7620/zgfybj.j.issn.1001-4411.2017.23.83.
[11]Tang R,Coopey SB,Colwell AS,et al.Nipple-sparing mastectomy in irradiated breasts:selecting patients to minimize complications[J].Ann Surg Oncol,2015,22(10):3331-3337.doi:10.1245/s10434-015-4669-y.
[12]鲁长存,陈俊国,王阁,等.不同术式联合调强放疗对乳腺癌患者生命质量和性生活的影响[J].局解手术学杂志,2017,26(4):267-270.doi:10.11659/jjssx.11E016047.
[13]Orzalesi L,Casella D,Santi C,et al.Nipple sparing mastectomy:Surgical and oncological outcomes from a national multicentric registry with913 patients(1006 cases)over a six year period[J].Breast,2016,25:75-81.doi:10.1016/j.breast.2015.10.010.
[14]Davila AA,Mioton LM,Chow G,et al.Immediate two-stage tissue expander breast reconstruction compared with one-stage permanent implant breast reconstruction:a multi-institutional comparison of shortterm complications[J].J Plast Surg Hand Surg,2013,47(5):344-349.doi:10.3109/2000656X.2013.767202.
[15]Manning AT,Wood C,Eaton A,et al.Nipple-sparing mastectomy in patients with BRCA 1/2 mutations and variants of uncertain significance[J].Br J Surg,2015,102(11):1354-1359.doi:10.1002/bjs.9884.
[16]文斌.保留乳头乳晕的乳腺癌改良根治术治疗乳腺癌的安全性[J].国际肿瘤学杂志,2017,44(1):49-52.doi:10.3760/cma.j.issn.1673-422X.2017.01.013.
[17]Chirappapha,Prakasit,Petit,et al.Nipple sparing mastectomy:does breast morphological factor related to necrotic complications?[J].Plast Reconstr Surg Glob Open,2016,2(1):e99.doi:10.1097/GOX.0000000000000038.
[18]王常珺,姚儒,周易冬,等.单切口环乳晕入路保留乳头乳晕乳腺癌改良根治术联合同期乳腺扩张器植入术的应用分析[J].中华内分泌外科杂志,2017,11(2):92-96.doi:10.3760/cma.j.issn.1674-6090.2017.02.002.
[19]刘梦友,金功圣,陈晨,等.保留乳头乳晕乳腺癌改良根治术后即刻扩展型背阔肌乳房再造术的临床应用[J].中国普通外科杂志,2018,27(5):601-607.doi:10.3978/j.issn.1005-6947.2018.05.012.
[20]Frederick MJ,Lin AM,Neuman R,et al.Nipple-sparing mastectomy in patients with previous breast surgery:comparative analysis of 775 immediate breast reconstructions[J].Plast Reconstr Surg,2016,27(1):55-57.doi:10.1097/PRS.0000000000001283.
[21]Moo TA,Pinchinat T,Mays S,et al.Oncologic outcomes after nipplesparing mastectomy[J].Ann Surg Oncol,2016,23(10):1-5.doi:10.1245/s10434-016-5366-1.
[22]刘学敏,顾瑞香,王海强,等.保留乳头乳晕复合体的乳腺癌术后即刻乳房重建术[J].中国美容整形外科杂志,2016,27(4):212-214.doi:10.3969/j.issn.1673-7040.2016.04.007.
[23]孙萍,梁栋.保留乳头乳晕改良根治术联合假体置入术对早中期乳腺癌患者免疫功能及负性情绪的影响[J].中国临床医生杂志,2018,46(4):453-456.doi:10.3969/j.issn.2095-8552.2018.04.026.
[24]Folli S,Mingozzi M,Curcio A,et al.Nipple-sparing mastectomy:an alternative technique for large ptotic breasts[J].J Am Coll Surg,2015,220(5):e65-e69.doi:10.1016/j.jamcollsurg.2015.01.028.