CAJ | 학술논문

目的：探讨腔镜辅助下保留乳头乳晕乳腺癌改良根治术Ⅰ期乳房重建的方法和疗效。方法：对28例Ⅰ、Ⅱ期乳腺癌患者行腔镜下腋窝淋巴结清扫保留乳头乳晕乳腺癌改良根治术，辅助腔镜下一期假体或扩张器植入乳房重建，Ⅱ期扩张器取出假体植入乳房重建。结果：28例中，7例一期植入硅凝胶假体，体积220~325ml。1例乳房体积小于对侧，化疗结束后3个月，更换较大假体。21例放置扩张器并注水380-500ml，其中3月后2例破裂，再次更换；1例放疗后皮肤破溃，假体外露，取出扩张器，未再更换。20例中放入扩张器6-15月后，化疗结束3月，放疗结束6月，全部更换为解剖型乳房假体；其中13例行健侧乳房上提缩小术，使两侧乳房对称。术后随访12-52个月,中位平均随访时间为32个月，全组无局部复发和远处转移。无包膜挛缩，乳房形态良好，美容效果满意。结论：腔镜辅助下保留乳头乳腺癌改良根治术假体或扩张器一期植入乳房重建，Ⅱ期扩张器取出更换解剖型假体，健侧乳房上提，可作为早期乳腺癌美容效果较好的一种手术治疗方法。
목적：탐토강경보조하보류유두유훈유선암개량근치술Ⅰ기유방중건적방법화료효。방법：대28례Ⅰ、Ⅱ기유선암환자행강경하액와림파결청소보류유두유훈유선암개량근치술，보조강경하일기가체혹확장기식입유방중건，Ⅱ기확장기취출가체식입유방중건。결과：28례중，7례일기식입규응효가체，체적220~325ml。1례유방체적소우대측，화료결속후3개월，경환교대가체。21례방치확장기병주수380-500ml，기중3월후2례파렬，재차경환；1례방료후피부파궤，가체외로，취출확장기，미재경환。20례중방입확장기6-15월후，화료결속3월，방료결속6월，전부경환위해부형유방가체；기중13례행건측유방상제축소술，사량측유방대칭。술후수방12-52개월,중위평균수방시간위32개월，전조무국부복발화원처전이。무포막련축，유방형태량호，미용효과만의。결론：강경보조하보류유두유선암개량근치술가체혹확장기일기식입유방중건，Ⅱ기확장기취출경환해부형가체，건측유방상제，가작위조기유선암미용효과교호적일충수술치료방법。
Objective:Discuss the me thod and efficacy of immediate breast construction with prosthesis after endoscopic-assisted nipple-sparing mastectomy. Methods: 28 stage-Ⅰ、 Ⅱ breast cancer patients had received nipple-sparing mastectomy with endoscopic axillary lymph node, immediately received prosthesis or tissue expander implanting surgery to reconstruct breast, replace the expander by the prosthesis in stage -two surgery. Results:In the 28 cases,7 cases received silicone breast implantation,the volume is 220-325ml, 1 cases replaced a larger prosthesis, after the end of chemotherapy 3 months,because of the asymmetric breasts. 21cases received tissue expander implantation, and inject 380-500ml saline. Among the 21 cases,2 patients replaced new expander because of the expander rupture; 1 remove the expander without other replacement, because the skin ulceration and the exposure of prosthesis after the radiotherapy. 20 cases,after the tissue expander implantation 6-15months, after the chemotherapy 3 months, after the radiotherapy 6 months, totally replaced the expander by the prosthesis,among the 20 cases, 13 cases received vertical lifting and reduction mammaplasty to the contralateral breast in order to achieve the symmetry of breasts. Patients were followed up 12-52 months(median 36 months) after operation, no local recurrence and distant metastasis. No capsular contracture, all cases got good breast shapes and satisfied with the cosmetic effect. Conclusion:Iimmediate breast construction with prosthesis after endoscopic-assisted nipple-sparing mastectomy,replace the expander by the prosthesis in stage -two surgery,with vertical lifting the contralateral breast,can be considered to be a effective cosmetic operation method to early stage breast cancer.