保留乳头乳晕的乳腺癌改良根治术和即时乳房假体重建

目的观察早期乳腺癌保留乳头乳晕的乳腺皮下切除,腋窝淋巴结清扫即期人工假体乳房重建手术的临床疗效。方法对20例早期乳腺癌患者（TNM分期：Ⅰ期6例,Ⅱ期14例）行保留乳头乳晕的的乳腺皮下切除,腋窝淋巴结清扫即期人工假体乳房重建手术,术后给予CMF（环磷酰胺、氨甲蝶呤、5-氟脲嘧啶）方案或FEC（5-氟脲嘧啶、表阿霉素、环磷酰胺）方案化疗,放疗及内分泌治疗等综合治疗。结果术后平均随访期为52．3个月,其中18例患者随访期超过36个月,全组患者均存活,无局部或区域肿瘤复发,1例患者在术后9个月发现多发肝转移及骨转移,现带瘤生存5年。结论保留乳头乳晕的乳腺皮下切除,腋窝淋巴结、清扫即期人工假体乳房重建手术并不增加术后并发症、肿瘤局部或区域复发、远处转移的危险性,不影响术后化疗、放疗及内分泌治疗等综合治疗和长期生存,该术式可获得满意的美容效果,从而进一步提高患者的生活质量。

Total mastectomy and axillary dissection with conservation of the nipple-areola complex, and immediate reconstruction with artificial prosthesis in the treatment of early breast cancer

OBJECTIVE: To study the feasibility of total mastectomy and axillary dissection with conservation of the nipple-areola complex, and immediate reconstruction with artificial prosthesis in the treatment of early breast cancer. METHODS: The 20 patients with breast cancer (TNM stage I, 6 patients; stage II, 14 patients) underwent the total mastectomy axillary dissection with conservation of the nipple-areola complex, and immediate reconstruction with artificial prosthesis. Post-operation they were given chemotherapy, radiotherapy, endocrine therapy. RESULTS: The mean follow-up for the entire group of 20 patients was 52.3 months, eighteen patients were more than 36 months. All patients were still alive, without local or regional recurrences. One patient suffered from multiple metastasis of liver and bone nine months after the operation, who has living five years now. CONCLUSION: Total mastectomy and axillary dissection with conservation of the nipple-areola complex, and immediate reconstruction with artificial prosthesis on selected patients with breast cancer is an oncologically acceptable procedure with superior cosmetic results, without increasing the risk of local recurrences, complications and influencing the effects of postoperative adjuvant treatment.