小通道乳房切除术中的肿胀和尖锐解剖与电灼解剖：一项真实世界的回顾性队列研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific Pub Date : 2025-02-01 DOI:10.1016/j.lanwpc.2024.101342

Yiwen Lu, Xinyu Ou, Zhihan Liu, Shicheng Su

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引用次数: 0

摘要

背景：在保留乳头乳房切除术（NSM）并立即进行假乳重建的微创手术中，在皮瓣发育过程中采用肿胀、尖锐或电灼技术。我们的研究评估了手术后技术对并发症的影响。方法在这项真实世界的回顾性队列研究中，来自中国12个中心的5436名NSM患者被确定。在排除和倾向评分匹配（PSM）之后，2016年1月至2022年12月期间，共有1252名女性乳腺癌患者接受了最小通道NSM并立即进行假体乳房重建。采用logistic回归分析探讨手术技术对围手术期结局及术后并发症的影响。显著性水平设为P<；. 05。在PSM后，我们发现肿胀和尖锐夹层组（n=313）患者的坏死并发症发生率显著降低(5.8% vs 13.0%；P= .001)，感染(2.6% vs 5.6%；P= 0.041)，种植体损失(0.3% vs 2.2%；P= 0.025)，平均手术时间较短(中位数[IQR] min， 177.0 [132.0-219.0] min, 201.0 [143.0-249.0] min；术中;.001)，与电切组比较（n=939）。解释：考虑到手术时间和手术并发症，在小切口NSM即刻假乳重建中，肿胀和尖锐剥离可能是跳跃式皮瓣发展的更好选择。一个限制是外科医生在多个中心的技能存在差异。国家重点研发计划项目（2023YFC3404500），国家自然科学基金项目（92057210,82125017,82173064,92359302,82322030），广州市科技计划项目（202103000070,202201020479），新基石科学基金项目（新基石研究者计划和XPLORER奖）。

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Tumescence and sharp versus electrocautery dissection in minimal access mastectomy: a real-world retrospective cohort study

Background

Tumescence and sharp or electrocautery techniques have been employed during skin flap development in minimal access nipple-sparing mastectomy (NSM) with immediate prosthesis breast reconstruction. Our study evaluated the impact of techniques on complications after this surgery.

Methods

In this real-world retrospective cohort study, 5436 individuals undergoing NSM from 12 centers in China were identified. After exclusions and propensity score matching (PSM), a total of 1252 female breast cancer patients who underwent minimal access NSM with immediate prosthesis breast reconstruction between January 2016 and December 2022 were included. The effect of surgical techniques on the perioperative outcomes and postoperative complications was investigated using logistic regression analysis. The level of significance was set at P< .05.

Findings

After PSM, we found that patients in the tumescence and sharp dissection group (n=313) experienced significantly lower rates of necrotic complications (5.8% vs 13.0%; P= .001), infection (2.6% vs 5.6%; P= .041), implant loss (0.3% vs 2.2%; P= .025), and had shorter mean operation time (median [IQR] min, 177.0 [132.0-219.0] min, and 201.0 [143.0-249.0] min; P< .001), compared with those in the electrocautery dissection group (n=939).

Interpretation

Tumescence and sharp dissection might be a better option in skip flap development during minimal access NSM with immediate prosthesis breast reconstruction, in regard to operation time and surgical complications. A limitation is the variation in surgeons’ skills across multiple centers.

Funding

National Key Research and Development Program of China (2023YFC3404500), the Natural Science Foundation of China (92057210, 82125017, 82173064, 92359302, 82322030), Science and Technology Program of Guangzhou (202103000070, 202201020479), and the New Cornerstone Science Foundation through the New Cornerstone Investigator Program and the XPLORER PRIZE.

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.