通过术中激光斑点对比成像（LSCI）监测乳头分离乳房切除术（NSM）中的乳腺模块化切除术（BMR）提高了研究员的手术培训效果

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer Pub Date : 2024-08-23 DOI:10.1016/j.clbc.2024.08.011

Ru Yao , Fengzhou Du , Runzhu Liu , Linjuan Tan , Jie Lian , Lu Gao , Hailin Zhang , Li Huang , Bo Pan , Yidong Zhou , Qiang Sun , Jun Zhao , Xiao Long

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引用次数: 0

摘要

乳头保留乳房切除术（NSM）和皮肤保留乳房切除术（SSM）对受训学员的外科培训具有挑战性。我们为 NSM/SSM 手术开发了一个具有乳腺模块化切除术（BMR）新概念的外科培训课程，并开展了这项研究，探讨与传统手术切除术（CPR）相比，BMR 是否能改善手术效果。本研究回顾了105名乳腺癌患者的病历，这些患者接受了NSM/SSM手术，并由受训人员进行了即刻重建。比较了两组患者的临床病理特征和手术效果。激光斑点对比成像（LSCI）用于术中评估NAC的血液供应，并进一步比较绝对灌注单位（PU）值和相对灌注单位（rPU）值。与心肺复苏组（= 53）相比，BMR 组（= 52）的手术训练结果改善不明显。NAC坏死率、皮瓣坏死率和植入物移除率均分别下降。在 60 例 NSM 患者中，BMR 组（= 30 例）的失血量（= .011）和手术时间（< .001）显著减少，其他结果改善不明显。未发生 NAC 坏死的患者的 PU 绝对值和 rPU 值均明显较高 ( < .001)。BMR 组的 PU 绝对值明显更高 ( = .002)。与 CPR 相比，基于 BMR 的 NSM 手术培训课程减少了并发症和手术时间，为 NSM 手术提供了一种潜在的简化、高效和安全的方法。LSCI 对术中可视化评估 NAC 供血非常有效，并能为学员提供有效的实时反馈。

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Breast Modular Resection (BMR) in Nipple-Sparing Mastectomy (NSM) With Intraoperative Laser Speckle Contrast Imaging (LSCI) Monitoring Improved Surgical Training Outcome Among Fellows

Background

Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are challenging for surgical training among fellow trainees. We developed a surgical training course with novel concept of breast modular resection (BMR) for NSM/SSM procedure, and performed this study to investigate whether BMR could improve surgical outcomes compared to classical procedure resection (CPR).

Methods

The records of 105 breast cancer patients undergoing NSM/SSM with immediate reconstruction performed by fellow trainees were reviewed. Clinicopathological characteristics and surgical outcomes were compared between 2 groups. Laser speckle contrast imaging (LSCI) was performed to intraoperatively evaluate the blood supply of the NAC, and the absolute perfusion unit (PU) values and relative perfusion unit (rPU) values were further compared.

Results

Surgical training outcomes of BMR group (N = 52) were insignificantly improved compared to CPR group (N = 53). The rates of NAC necrosis, flap necrosis and implant removal all reduced respectively. Among the 60 NSM patients, the blood loss (P = .011) and surgery time (P < .001) was significantly reduced in BMR group (N = 30) and all the other outcomes were insignificantly improved. Both the absolute PU values and rPU values were significantly higher among patients without NAC necrosis (P < .001). The absolute PU values were significantly higher in BMR group (P = .002).

Conclusion

Compared to CPR, the BMR-based surgical training course for NSM demonstrated the reduction in complications and operating time, offering a potential streamlined, efficient, and safe method for NSM procedure. LSCI was effective for intraoperative visualized evaluation of NAC blood supply and could provide effective real-time feedback for fellow trainees.

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来源期刊

Clinical breast cancer 医学-肿瘤学

CiteScore

5.40

自引率

3.20%

发文量

174

审稿时长

48 days

期刊介绍： Clinical Breast Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of breast cancer. Clinical Breast Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of breast cancer. The main emphasis is on recent scientific developments in all areas related to breast cancer. Specific areas of interest include clinical research reports from various therapeutic modalities, cancer genetics, drug sensitivity and resistance, novel imaging, tumor genomics, biomarkers, and chemoprevention strategies.