保留乳头乳晕复合体早期乳腺癌外科治疗临床应用

目的 探讨保留乳头乳晕复合体（nipple-areolar complex,NAC）对乳腺癌患者乳房重建的美容效果和术后生活质量的意义,比较保留NAC的改良根治术与传统改良根治性手术治疗早期乳腺癌疗效.方法 回顾性分析2008年1月~2011年10月在我院接受早期乳腺癌行保留乳头乳晕复合体的改良根治术的患者60例,根据发病年龄、腋窝淋巴结状态、激素受体情况、肿块大小和Her-2/neu的表达状态5个变量对60例接受保留NAC改良根治术患者（观察组）和60例接受传统改良根治术患者（对照组）的按1∶1比例进行配对的回顾性队列研究.比较两组的局部区域复发率、远处转移率、总生存率和无瘤生存率.结果 两组患者手术均获得成功,观察组术后并腋窝积液3例,经重新置管引流1周治愈;无乳房皮瓣坏死.对照组并腋窝积液3例,乳头表皮部分坏死3例,1个月左右痂下愈合,皮瓣其他部位均无明显坏死.观察组优60.00%（36/60）,良40.00%（24/60）;对照组乳头乳晕外观正常,优40.00%（24/60）,良41.67%（25/60）,乳头轻度萎缩11例,占18.33%,两种术式差异有统计学意义（P ＜ 0.05）.两组患者均随访26～46个月,中位随访时间为34个月,所有患者均无瘤生存.结论 在严格把握适应证基础上行保留NAC改良根治术治疗早期乳腺癌可以和传统的改良根治术取得相似的治疗效果,且可以增强患者乳房的美容效果和提高术后生活质量,值得推广.

Clinical application on nipple-areolar complex in surgical treatment of early breast cancer

Objective To explore the significance of cosmetic effect of breast reconstruction and the life quality in patients with breast cancer treated by nipple-areolar complex,and to compare the effectiveness between the traditional modified radical mastectomy and modified radical mastectomy of nipple-areolar complex.Methods 60 patients with early breast cancer treated by modified radical mastectomy of NAC in the hospital which were collected from Jan 2008 to Oct 2011 had been retrospective analyzed.60 patients undergoing NAC modified radical mastectomy(defined as observed group) and 60 cases accepting traditional modified radical mastectomy(defined as control group),the retrospective cohort study were carried out with 1:1 matched pair study according to the age,axillary lymph node status,situation of hormone receptor,the tumor size and expression of Her-2/neu.The incidence of loco regional recurrence,the rate of distant metastases,overall survival rate and disease-free survival rate were measured between two groups.Results Both patients were performed successfully in two groups.3 cases appeared axillary effusion and healed by restarting catheter drainage for one week without skin flap necrosis.36 patients(60.00%) achieved excellent effect of beauty and 24 cases(40.00%) for good in observed group as well as 24 cases for excellent and 25 ones for good were in control group.The nipple and areola were normal appearance,but 11 cases(18.33%) had mild papillary atrophy.The difference was significant between two operation methods(P < 0.05).All patients had been followed up for 26 to 46 months,the median follow-up time was 34 months.All patients were disease-free survival.Conclusion Compared to traditional modified radical mastectomy,the NAC modified radical mastectomy can achieve the similar effect on the basis of strict indications,but it can improve the cosmetic effect and the life quality and is worth promoting.