空军军医大学学报2025，Vol.46Issue(9)：1133-1142,10.DOI:10.13276/j.issn.2097-1656.2025.09.003
腔镜手术与开放手术在乳腺癌一期假体重建术的回顾性队列研究
A retrospective cohort study of endoscopic surgery and open surgery in nipple-sparing mastectomy with immediate reconstruction for breast cancer
摘要
Abstract
Objective To explore the efficacy and safety of endoscopic nipple-sparing mastectomy(E-NSM)with immediate reconstruction for breast cancer.Methods This study retrospectively investigated 257 patients who underwent nipple-sparing mastectomy at the Department of Thyroid,Breast and Vascular Surgery,Xijing Hospital,Air Force Medical University from January 1,2019 to December 31,2022.Among them,142 patients received conventional open surgery,while 115 patients received endoscopic-assisted surgery.The clinical data of these patients were retrospectively analyzed,including pathological characteristics,surgical procedures,operative time,prosthesis size,flap necrosis,and postoperative infection rates.The BREAST-Q 2.0 questionnaire was used to assess patient satisfaction and quality of life.Results No statistically significant difference was observed in operative time between the conventional nipple-sparing mastectomy group(C-NSM group)and E-NSM group[130(110,170)minvs 135(110,175)min,P=0.232 9].However,the C-NSM group had significantly larger implant compared to the E-NSM group[(236.78±47.36)mL vs(218.52±50.52)mL,P=0.003 8].The median follow-up duration was significantly longer in the C-NSM group than that in the E-NSM group[48(32,58)months vs 32(26,40)months,P＜0.000 1].During postoperative follow-up,although the C-NSM group exhibited a higher number of implant loss compared to the E-NSM group[9 cases(6.34％)vs 2 cases(1.74％)],the difference between the two groups was not statistically significant(P＞0.05).In terms of short-term postoperative complications,including hemorrhage,flap ischemia,nipple-areola complex ischemia,and infection,the C-NSM group demonstrated a significantly higher complication rate compared to the E-NSM group,with statistically significant difference(P＜0.05).At the final follow-up,the E-NSM group demonstrated superior BREAST-Q 2.0 scores in breast satisfaction,psychosocial well-being,and chest pain compared to the C-NSM group,with statistically significant difference(P＜0.05).During the long-term postoperative follow-up period,3 patients in the C-NSM group and 2 patients in the E-NSM group experienced local recurrence,and only one case of distant metastasis was observed in the C-NSM group.In terms of endoscopic operations,the operative time was analyzed,and it was found that the learning curve gradually shortened with the accumulation of surgical experience and case numbers over time.Conclusion E-NSM causes less damage compared with traditional open surgery,and the operative time is not prolonged,with fewer postoperative complications,superior aesthetic outcomes,and short learning curve,demonstrating promising clinical application potential.关键词
乳腺肿瘤/腔镜手术/传统开放手术/胸肌前乳房重建/胸肌后乳房重建/内窥镜检查/坏死/治疗结果Key words
breast neoplasms/endoscopic surgery/conventional open surgery/prepectoral breast reconstruction/subpectoral breast reconstruction/endoscopy/necrosis/treatment outcome分类
医药卫生引用本文复制引用
王邑迪,张聚良,王廷,訾浩毅,丁嘉珺,孟慧敏,李孟轩,孔静,李松朋,樊菁,李南林..腔镜手术与开放手术在乳腺癌一期假体重建术的回顾性队列研究[J].空军军医大学学报,2025,46(9):1133-1142,10.基金项目
陕西省自然科学基础研究计划青年项目(2023-JC-QN-0982) （2023-JC-QN-0982）
陕西省乳腺癌专病数据信息库建设项目(2022-08-22) （2022-08-22）
