乳腺癌术后Ⅰ期乳房再造中腔镜与开放假体重建的单中心回顾性研究

目的 比较腔镜下乳房切除术后即刻植入物重建与开放手术的并发症与满意度相关分析。方法 纳入2019年1月—2022年5月本院收治早期乳腺癌接受术后乳房即刻重建的患者96例，分为腔镜手术组36例，开放手术组60例。采用行非参数检验、Mann-Whitney U检验、Logistic 回归分析比较两组患者年龄、肿瘤位置、手术方式、组织学分级、新辅助化疗、辅助化疗、放疗、是否保留乳头乳晕、有无并发症、是否局部复发及满意度相关因素。结果 两组患者年龄经非参数检验差异无统计学意义（P＞0.05）。组织学分级、肿瘤位置、新辅助化疗、是否保留乳头乳晕的构成比存在显著差异（P＜0.05），手术方式、辅助化疗、辅助放疗、术后并发症与局部复发在不同组别之间经 构成比差异无统计学意义（P＞0.05）。在单因素Logistic 回归中行前哨淋巴结活检、腋窝淋巴结清扫术、新辅助化疗治疗、辅助放疗治疗、保留乳头乳晕与即刻乳房重建术后并发症的发生具有相关性（P＜ 0.05）。多因素分析提示，腋窝淋巴结清扫、假体体积、高血压、保留乳头乳晕是并发症发生率的相对独立的影响因素。结论 单孔充气法腔镜辅助乳房皮下切除假体植入Ⅰ期乳房重建对于符合条件的乳腺癌安全可行，具有创口小、并发症发生率低及相关风险可控,获得较好的根治效果和乳房形态，患者生活质量和满意度高，可在临床推广应用

A retrospective study of immediate reconstruction using implants with different surgical methods in early breast cancer

Objective To compare the complications and satisfaction of immediate implant reconstruction and open surgery after endoscopic mastectomy. Methods From January 2019 to May 2022, 96 patients with early breast cancer who underwent immediate postoperative breast reconstruction were treated in our department. There were 36 cases in the endoscopic surgery group and 60 cases in the open surgery group. Nonparametric test, Mann-Whitney U test, and Logistic regression analysis were used to compare the age, tumor location, surgical method, histological grade, neoadjuvant chemotherapy, adjuvant chemotherapy, radiotherapy, Whether the nipple and areola are preserved, whether there are complications, whether there is local recurrence and related factors of satisfaction.Results The age and histological grade of the two groups were not statistically significant by nonparametric test（P＞0.05）There were significant differences in the composition ratio of tumor location, neoadjuvant chemotherapy, and nipple and areola preservation（P＜0.05）There was no significant difference in the composition ratio of surgery, adjuvant chemotherapy, adjuvant radiotherapy, postoperative complications and local recurrence among different groups by test (P＞0.05) In univariate Logistic regression, sentinel lymph node biopsy, axillary lymph node dissection, neoadjuvant chemotherapy, adjuvant radiotherapy, and nipple and areola preservation were associated with complications after immediate breast reconstruction (P＜ 0.05)Multivariate analysis suggested that axillary lymph node dissection, prosthesis volume, high blood pressure, nipple and areola preservation were relatively independent factor for the incidence of complications. Conclusion Endoscope-assisted subcutaneous mastectomy with single-port inflatable and prosthesis implantation with stage I breast reconstruction is safe and feasible for eligible breast cancer, including the advantages of minimally invasive, low incidence of complications and related risks can be controlled, better radical effect and cosmetic effect can be achieved, the quality of life and satisfaction of patients are higher, which can be promoted in clinical application