腋窝入路与侧方入路腔镜保留乳头乳晕乳腺癌根治切除加假体植入乳房重建术的疗效比较

背景与目的 近年来，腔镜保留乳头乳晕乳腺癌根治切除（NSM）加假体植入乳房重建术的开展逐渐增多。腔镜手术的入路多种多样，目前主要是腋窝入路与侧方入路，然而目前对两种入路手术效果的比较研究仍少有报道，因此，本研究对腋窝入路与侧方入路行腔镜NSM加假体重建手术的疗效进行比较，以期为临床选择合适的腔镜手术入路提供参考。方法 回顾性收集中国人民解放军陆军军医大学第一附属医院乳腺甲状腺外科2016年1月—2022年10月152例行腔镜NSM加假体植入乳房重建术乳腺癌患者临床资料。按手术入路分为腋窝入路组（78例）与侧方入路组（74例），比较两组患者的相关临床指标。结果 两组患者的基线资料差异无统计学意义（均P>0.05）。侧方入路组手术时间短于腋窝入路组（211.50 min vs. 250.00 min，P<0.001），引流量少于腋窝入路组（300.50 mL vs. 504.50 mL，P<0.001），腋窝入路组行胸肌前假体植入比例明显高于侧方入路组（24.4% vs. 6.8%，P=0.003），两组术中出血量、术后引流时间差异无统计学意义（均P>0.05）。两组患者术后血肿、感染、积液、乳头乳晕或皮瓣坏死、包膜挛缩发生率差异均无统计学意义（均P>0.05）。术后随访6个月结果显示，两组患者乳房外形、生活质量情况及术后满意度（腋窝入路：91.0% vs. 侧方入路：91.9%）差异均无统计学意义（均P>0.05）。两组在远处转移、局部复发、总生存率差异均无统计学意义（均P>0.05）。结论 经腋窝入路和侧方入路NSM加假体植入乳房重建的两种入路方式均安全有效，美学效果无差异。腋窝入路适合进行胸肌前假体植入，侧方入路操作简便，手术时间短，利于保留胸肌筋膜，可进行免补片的胸肌后假体植入。

Comparison of the efficacy of endoscopic nipple-sparing mastectomy with prosthetic breast reconstruction via axillary and lateral approaches

Background and Aims In recent years, the implementation of endoscopic nipple-sparing mastectomy (NSM) with prosthetic breast reconstruction has increased. Various approaches for endoscopic surgery exist, with the axillary and lateral approaches being the most common. However, comparative studies on the surgical outcomes of these two approaches are limited. Therefore, this study was performed to compare the efficacy of endoscopic NSM with prosthetic reconstruction via the axillary and lateral approaches, providing clinical references for selecting the appropriate endoscopic surgical approach.Methods The clinical data of 152 breast cancer patients who underwent endoscopic NSM with prosthetic breast reconstruction from January 2016 to October 2022 in the Department of Breast and Thyroid Surgery of the First Affiliated Hospital of the Army Medical University were retrospectively collected. The patients were divided into the axillary approach group (78 cases) and the lateral approach group (74 cases) based on the surgical approach. Relevant clinical variables were compared between the two groups.Results There was no statistically significant difference in baseline data between the two groups (all P>0.05). The lateral approach group had a shorter operative time (211.50 min vs. 250.00 min, P<0.001) and less drainage volume (300.50 mL vs. 504.50 mL, P<0.001) compared to the axillary approach group. The axillary approach group had a significantly higher proportion of prepectoral prosthetic breast reconstruction compared to the lateral approach group (24.4% vs. 6.8%, P=0.003). There were no statistically significant differences between the two groups in intraoperative blood loss, postoperative drainage time, postoperative hematoma, infection, seroma, nipple-areola or skin flap necrosis, or capsular contracture rates (all P>0.05). Six-month postoperative follow-up showed no significant differences between the two groups in breast shape, quality of life, and postoperative satisfaction (axillary approach: 91.0% vs. lateral approach: 91.9%) (all P>0.05). Additionally, there were no significant differences in distant metastasis, local recurrence, or overall survival rates between the two groups (all P>0.05).Conclusion Both the axillary and lateral approaches for NSM with prosthetic breast reconstruction are safe and effective, with no differences in aesthetic outcomes. The axillary approach is suitable for prepectoral prosthetic implantation, while the lateral approach is simpler, shortens operation time, preserves the pectoral fascia, and allows for subpectoral prosthetic implantation without the need for a reinforcement mesh.