腋窝入路单孔腔镜行保留乳头乳晕皮下腺体全切除联合一期假体植入术的疗效观察

doi:10.3969/j.issn.1009-976X.2026.04.002

摘要/Abstract

摘要： 目的初步分析腋窝入路单孔腔镜行保留乳头乳晕皮下腺体全切除联合一期假体植入术治疗早期乳腺癌的效果。方法收集2022年2月至2025年2月在江门市中心医院收治的行保留乳头乳晕皮下腺体切除（NSM）联合一期假体植入术的126例早期乳腺癌患者临床资料。依据手术方式分为腔镜组（腋窝入路单孔腔镜行NSM联合一期假体植入,共74例）和开放组（开放行NSM联合一期假体植入,共52例）。比较两组围手术期指标、并发症、预后及患者对乳房外观满意度。结果腔镜组术后1年BREAST-Q乳房满意度评分[71（64,82）分]高于开放组[64（61,82）分]（P=0.031）。腔镜组术后72 h引流量（265±116 mL vs. 340±194 mL,P=0.014）及住院时间（12.43±3.46 d vs. 14.17±3.82 d,P=0.009）均少于开放组。两组术后出血或感染、乳头乳晕或皮瓣缺血坏死、假体取出率无显著差异（P>0.05）。中位随访2年,腔镜组出现2例（2.7%）局部腋窝淋巴结复发转移,开放组出现同侧锁骨上淋巴结及胸壁复发转移各1例（3.8%）,两组均无远处复发转移,组间差异无统计学意义（P=1.000）。结论腋窝入路单孔腔镜NSM联合一期假体胸肌前植入术治疗可减少术后引流量、缩短住院时间、提高患者乳房外观满意度。

关键词: 乳腺肿瘤, 早期乳腺癌, 腔镜, 保留乳头乳晕, 乳房植入物

Abstract: Objective To evaluate the efficacy of transaxillary single-port endoscopic nipple-sparing mastectomy （NSM） with immediate implant-based breast reconstruction for early-stage breast cancer. Methods We retrospectively analyzed 126 patients with early-stage breast cancer who underwent NSM with immediate prepectoral implant-based reconstruction at Jiangmen Central Hospital from February 2022 to February 2025. Based on the surgical procedure, they were divided into an endoscopic surgery group （74 patients） and an open surgery group （52 patients）. The endoscopic group received transaxillary single-port endoscopic nipple-sparing mastectomy with immediate prepectoral implant-based reconstruction, while the open group received conventional open nipple-sparing mastectomy with the same type of breast reconstruction. We compared the two groups on perioperative indicators （operative time, 72-hour postoperative drainage volume, and length of stay）, complications, prognosis, and patient satisfaction with breast reconstruction. Results The endoscopic group reported higher BREAST-Q breast satisfaction scores at 1 year postoperatively [71 （64, 82） vs. 64 （61, 82）, P=0.031]. The endoscopic group also had lower 72-hour postoperative drainage volume （265±116 mL vs. 340±194 mL, P=0.014） and a shorter hospital stay （12.43±3.46 days vs. 14.17±3.82 days, P=0.009） than the open group. No significant differences were observed between the two groups in postoperative bleeding or infection, nipple-areolar or flap ischemia/necrosis, or implant removal rate （all P>0.05）. Over a median follow-up of 2 years, local axillary lymph node recurrence occurred in 2 patients （2.7%） in the endoscopic group, while in the open group, 1 patient developed ipsilateral supraclavicular lymph node recurrence and 1 developed chest wall recurrence （3.8% overall）, with no significant intergroup difference （P=1.000）. No distant recurrence was observed in either group. Conclusion Transaxillary single-port endoscopic NSM with immediate prepectoral implant reconstruction appears to reduce postoperative drainage volume, shorten hospital stay, and improve patient satisfaction with breast appearance.

Key words: breast neoplasms, early-stage breast cancer, endoscopy, nipple-sparing mastectomy, breast implants

中图分类号:

温俊洪, 蔡嘉敏, 黄潇梅, 关健华. 腋窝入路单孔腔镜行保留乳头乳晕皮下腺体全切除联合一期假体植入术的疗效观察[J]. 岭南现代临床外科, 2026, 25(04): 215-221.

WEN Junhong, CAI Jiamin, HUANG Xiaomei, GUAN Jianhua. Evaluation of the efficacy of transaxillary single-port endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction[J]. Lingnan Modern Clinics In Surgery, 2026, 25(04): 215-221.

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