逆序内窥镜保留乳头乳房切除术，直接植入乳房重建和空气膨胀调节技术用于大乳房或严重上睑下垂患者：一项单中心前瞻性队列研究

IF 12.5 2区医学 Q1 SURGERY

International journal of surgery Pub Date : 2025-04-10 DOI:10.1097/JS9.0000000000002389

Hui Dai, Xiaoman Cao, Hao Wu, Faqing Liang, Yanyan Xie, Kawun Chung, Qing Zhang, Tianyuan Li, Zhenggui Du

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引用次数: 0

摘要

背景：逆序内窥镜保留乳头乳房切除术（R-E-NSM）与直接植入乳房重建术（DIBR）在大乳房或严重下垂（LSPB）患者中的适用性值得探讨，这些患者在开放性NSM、传统内窥镜NSM和机器人NSM中不被推荐或甚至被认为是禁忌。该研究旨在比较LSPB和非LSPB （NLSPB）患者接受R-E-NSM合并DIBR的安全性和美观结果。材料和方法：单中心前瞻性队列研究纳入562例接受R-E-NSM和DIBR的患者。比较LSPB和NLSPB患者的手术安全性、美观性和肿瘤学安全性。结果：倾向评分匹配后，纳入88例LSPB患者和256例NLSPB患者（中位[IQR]随访时间：21.0[13.8,32.4]对23.0[10.6,32.2]个月，P = 0.889）。LSPB组乳腺切除重量明显高于对照组（576.6±144.8 g vs. 330.1±105.7 g, P < 0.001）。LSPB组和NLSPB组的并发症（27.3%比22.7%,P = 0.381）、严重并发症（6.8%比3.1%,P = 0.230）、轻微并发症（20.5%比21.1%,P = 0.889）和种植体相关并发症（21.6%比24.6%,P = 0.566）差异均无统计学意义。在LSPB组中，采用空气充气调节技术（AIAT）患者的Ueda评分优于未采用AIAT的患者，但差异无统计学意义（P = 0.110）。与未进行AIAT的NLSPB组相比，进行AIAT的LSPB组的Ueda评分相似（P = 0.870），乳房满意度的breast - q评分显著提高（P = 0.004）。两组肿瘤预后无显著差异（P < 0.05）。结论：R-E-NSM联合DIBR和AIAT为LSPB和NLSPB患者提供了相当的手术安全性和美观效果，为LSPB患者提供了新的选择。

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Reverse‑sequence endoscopic nipple‑sparing mastectomy with direct‑to‑implant breast reconstruction and air inflation adjustment technique in patients with large or severely ptotic breast: a single-center prospective cohort study.

Background: The applicability of reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with direct-to-implant breast reconstruction (DIBR) is worth exploring in patients with large or severely ptotic breasts (LSPB) who were not recommended or even considered contraindicated in open NSM, conventional endoscopic NSM, and robotic NSM. The study aimed to compare the safety and aesthetic outcomes between patients with LSPB and non-LSPB (NLSPB) undergoing R-E-NSM with DIBR.

Materials and methods: The single-center prospective cohort study enrolled 562 patients undergoing R-E-NSM and DIBR. Surgical safety, aesthetic outcomes, and oncologic safety were compared between patients with LSPB and NLSPB.

Results: After propensity score matching, 88 LSPB patients and 256 NLSPB patients were included (median [IQR] follow-up time: 21.0 [13.8, 32.4] vs. 23.0 [10.6, 32.2] months, P = 0.889). The mastectomy weight was significantly higher in the LSPB group (576.6 ± 144.8 g vs. 330.1 ± 105.7 g, P < 0.001). There were no significant differences in any complications (27.3% vs. 22.7%, P = 0.381), major complications (6.8% vs. 3.1%, P = 0.230), minor complications (20.5% vs. 21.1%, P = 0.889) and implant-related complications (21.6% vs. 24.6%, P = 0.566) between the LSPB and the NLSPB groups. In the LSPB group, the Ueda scores in patients with air inflation adjustment technique (AIAT) were better than those without AIAT, though no significant difference (P = 0.110). Compared to the NLSPB group without AIAT, the LSPB group with AIAT had similar Ueda scores (P = 0.870) and a significantly higher increase in BREAST-Q scores of breast satisfaction (P = 0.004). Oncologic outcomes had no significant difference between the two groups (all P>0.05).

Conclusion: R-E-NSM with DIBR and AIAT provides comparable surgical safety and aesthetic outcomes for patients with LSPB and NLSPB, offering a new option for LSPB patients.

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来源期刊

International journal of surgery SURGERY-

CiteScore

17.70

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.