日间乳腺癌皮下单纯切除术后一期假体重建的华西经验
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四川省科技计划资助项目(2019YFH0146;2020YFS0199;2021YFS0104)。


Same-day skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction for breast cancer: West China Hospital experience
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    摘要:

    背景与目的:乳腺癌术后一期乳房重建在不影响患者治疗效果的同时,能显著改善患者的生活质量,因此已经成为乳腺癌手术治疗的一种重要方式。由于乳腺癌重建手术相对于乳房其他手术而言更复杂,耗时也更长,因此大多乳腺癌需乳房重建患者都是收入住院部手术,术后适当观察数天,本文总结华西医院14例乳腺癌行日间乳房重建手术的相关经验,并探讨其安全性及患者满意度。
    方法:回顾华西医院2020年4月—2020年10月14例行日间乳腺癌皮下单纯切除术后一期假体重建术的女性乳腺癌患者临床资料,分析相关的医患要求、手术流程、手术安全性、术后患者满意度及日间重建手术注意事项。
    结果:14例患者平均年龄42.6岁,大部分(11/14)为浸润性乳腺癌,均成功实施日间乳腺癌皮下切除术后一期假体重建,其中10例行腔镜乳房重建,4例行开放乳房重建。手术时间为146~215 min。术后随访3~9个月,无1例患者发生严重术后并发症,仅有2例发生轻微并发症,其中1例患者出现轻度皮瓣缺血,1例患者出现血清肿,均经观察后好转。根据Harris标准,术后3个月患者乳房满意度评价均为优良,术前与术后3个月BREAST-Q评分分别为:乳房满意度62.2、59.6分,性生活满意度59.9、51.0分,社会心理状况71.5、67.9分,胸部功能59.5、60.0分。
    结论:在常规乳腺癌日间手术的基础上开展的日间乳腺癌皮下切除后一期假体重建术可以获得与住院患者相同的安全性与满意度,在一定程度上可以缓解就医矛盾,增加医疗资源利用率,并且还可以减少医疗费用,具有良好的应用前景。

    Abstract:

    Background and Aims: Immediate breast reconstruction after mastectomy for breast cancer has become an important method of breast cancer surgical techniques, since it does not affect the treatment effect, and meanwhile, it can significantly improve the patients’ quality of life. Compared to other breast surgeries, mastectomy with reconstruction is more difficult to perform and time-consuming, so most breast cancer patients who need reconstruction are admitted to inpatient department for surgery and are properly observed for several days after operation. Here, the authors present the experience of 14 cases of breast cancer undergoing same-day immediate breast reconstruction in West China Hospital and discussed its safety and patients’ satisfaction.  
    Methods: The clinical data of 14 women with breast cancer undergoing same-day skin-sparing mastectomy surgery and immediate implant-based breast reconstruction from April 2020 to October 2020 in West China Hospital were reviewed. The data concerning doctor-patient requirement, surgical procedure, surgical safety, postoperative patients’ satisfaction and cautions for same-day reconstruction surgery were analyzed. 
    Results: The 14 patients had an average age of 42.6 years, and most of them were diagnosed as invasive breast cancer. The same-day skin-sparing mastectomy for breast cancer and immediate prosthetic breast reconstruction was successfully performed in all patients, including 10 cases of endoscopic reconstruction and 4 cases of open reconstruction. The operative time ranged from 146 to 215 min. During postoperative follow-up period for 3 to 9 months, no serious complications occurred, and only minor complications occurred in two patients, including one case of mild ischemia of flap and one case of seroma, and were all resolved after observation. According to Harris standard, the patients' satisfaction with the reconstructed breast were all expressed as excellent or good on postoperative 3 months. The BREAST-Q scores before and 3 months after operation were 62.2 and 59.6 for breast satisfaction, 59.9 and 51.0 for sexual well-being, 71.5 and 67.9 for psychosocial well-being, and 59.5 and 60.0 for physical well-being (chest), respectively. 
    Conclusion: Same-day skin-sparing mastectomy surgery with immediate prosthetic breast reconstruction on the basis of the routine breast cancer day surgery can obtain the same safety and satisfaction as inpatients, alleviate the hospitalization stress to a certain extent, increase the utilization rate of medical resources, and reduce the medical costs. So, it may have a broad application prospect. 

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冯玉,谢妍妍,梁法清,文楠,周娇,张颂博,刘馨然,黄艺璇,邱梦雪,杨焕佐,吕青,杜正贵.日间乳腺癌皮下单纯切除术后一期假体重建的华西经验[J].中国普通外科杂志,2021,30(5):543-550.
DOI:10.7659/j. issn.1005-6947.2021.05.006

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  • 收稿日期:2021-01-29
  • 最后修改日期:2021-05-25
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  • 在线发布日期: 2021-09-03