乳腺癌保乳手术保留乳头塑型对乳房外形的影响

【目的】探讨乳腺癌手术患者保持乳头外形重塑对乳房外形的影响。【方法】选择本院乳腺癌实行保乳手术患者28例，评估术后乳头塑型的美观效果，从双乳头水平、双乳头距同侧腋前线垂直距离、瘢痕对乳房外观的影响、乳头外观对保留乳房外形的重塑效果评价及对乳房外形的影响因素进行分析。【结果】术后切口达一期愈合24例，占85．71％，优良率为78．57％（22／28）；乳房外形未达理想标准者6例，占21．43％，其中切口瘢痕致乳房畸形3例，占10．71％，乳头不自然挺立、乳头歪斜及两侧乳头水平高度存在差距各1例，各占3．57％（1／28）。多因素非条件Logistic回归分析结果显示：切除乳腺组织的量、手术切口的设计、术中皮瓣的厚薄、术后切口包扎松紧度与术后乳头塑型影响因素显著相关。【结论】乳腺癌保乳手术乳头外形重塑是影响手术成功满意率的重要因素，术中保留乳腺组织的切除量、术前手术切口的设计、术后切口包扎、术中应瓣的犀薄与术后乳房外形影响因素显著相关。

Analysis of the Effect of Breast Conserving Operation for Breast Nipple Preserving and Remode- ling on the Shape of Breast

Objective]To explore the effect of breast nipple preserving and remodeling of patients under- going breast cancer operation on breast shape. Methods]Totally 28 patients with breast cancer undergoing breast conserving operation in our hospital were chosen. The beautiful outlook after breast nipple remodeling was evaluated. From the level of both nipples, vertical distance between nipples and anterior axillary line, the influence of scar on the appearance of breast, breast appearance, the efficacy of breast nipple preserving and remodeling was assessed. The influential factors of breast appearance were analyzed. Results] The postoper- ative incision with one-stage healing occupied 85.71% and the excellent rate was 78. 57% （22/28）. Breast ap- pearance without up to the ideal standard occupied 21. 43% （6/28）, including breast deformity caused by inci- sion scar（10.71 %, 3/28）, unnatural erect of nipple（3.57%, 1/28）, deflection of nipple（3.57%, 1/28） and both sides of nipples with different level height（3.57%, 1/28）. Multiple-factor unconditional logistic regres- sion analysis results showed that the amount of mammary gland excision, surgical incision design, thickness of intraoperative flap and the tightness of postoperative incision bandage were significantly related with the influ- ential factors of postoperative nipple remodeling. Conclusion] Breast nipple preserving and shape remodeling of patients with breast cancer is the important factor influencing the successful rate of the operation. The intra- operative resection amount of breast tissue, preoperative design of surgical incision, postoperative incision bandage and thickness of intraoperative flap are significantly correlated to the influential factors of postopera- tive breast shape.