保留乳头乳晕的乳腺癌改良根治术159例报告

目的 总结保留乳头乳晕复合体( nipple-areola complex，NAC)的乳腺癌改良根治术经验，以期提高手术成功率。方法 对1998年1月至2009年12月行保留NAC乳腺癌改良根治术的159例患者的临床病理资料进行回顾。结果 159例患者中成功实施保留NAC乳腺癌改良根治术141例(88.68％)。术中放弃保留NAC而改变为乳腺癌改良根治术或根治术14例(8.81％)，其中4例(2.52％)为术中发现NAC缺血，5例(3.14％) NAC有癌浸润，2例(1.26％)为重度不典型增生，3例(1.89％)因术中发现Ⅲ级淋巴结肿大而更改术式；术后乳头完全坏死导致手术失败4例(2.52％)。术后并发症：乳头部分缺血坏死16例(10.06％)，皮瓣坏死、感染11例(6.92％)，皮下积液10例(6.29％)。患者均获得随访，随访时间15 ～96个月（中位随访时间51个月）。术后局部复发5例(3.14％)，远处转移2例(1.26％)，NAC及其基底部未见复发。结论 保留NAC乳腺癌改良根治术在严格入组条件和手术流程的情况下是安全的术式，导致改变术式的常见原因为NAC癌浸润、NAC缺血坏死及术中分期改变等。

Nipple-areola complex sparing modified radical mastectomy for breast cancer: report of 159 cases

Objective To evaluate nipple-areola complex sparing modified radical mastectomy for breast cancer. Methods Clinical data of 159 breast cancer cases undergoing NAC sparing modified radical mastectomy from Jan 1998 to Dec 2009 were retrospectively analyzed.Results NAC sparing modified radical mastectomy was successfully carried out in 141 out of the 159 cases ( 88.68％ ). In 14 cases (8. 81％ ) the original operative protocol was changed to modified radical mastectomy or radical mastectomy during the operations because NAC ischemia in 4 (2. 52％ )cases, NAC occult involvement or dysplasia in 5 cases (3. 14％ ), Ⅲ level lymph node metastasis was found in 3 cases (1.89％). Postoperative complete nipple necrosis occurred in 4 (2. 52％ ) cases. Other significant postoperative complications included nipple necrosis in 20 cases ( 12. 58％ ), skin flap necrosis and infection in 11 cases ( 6.92％ ), subcutaneous hydrops in 10 cases (6. 29％ ). All patients got follow-up ranging from 15 to 96 months,median follow-up was 51 months. Local region recurrences were observed in 5 cases (3. 14％ ), distant metastasis in 2 cases ( 1.26％ ). There was no recurrence in the region of NAC. Conclusions Nipple-areola complex sparing modified radical mastectomy is oncologically safe by strict preoperative selection criteria and strict operative procedure.