[The comparative study of endoscope versus open surgery on nipple sparing mastectomy with immediate reconstruction using prosthesis implantation].

Objective: To compare the clinical efficacy between endoscopic nipple-sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery. Methods: Totally 189 early-stage breast cancer patients admitted at Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University from January 2013 to December 2017 were enrolled. Among them, 104 patients underwent endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation (endoscopic group), with an age of (41.7±6.1) years (range: 25 to 51 years), and 85 patients underwent traditional open surgery (open group), with an age of (41.6±7.7) years (range: 27 to 67 years). The operative duration, the volume of intraoperative blood loss, the volume of drainage in 3 days after surgery, postoperative complications and patients' satisfaction of breast reconstruction were compared between the two groups using t test, Mann-Whitney U test, χ(2) test or non-parametric test. Results: There were no statistically significant differences in postoperative complications, the rates of recurrence and overall survival between the two groups (P>0.05). The operative duration (sentinel lymph node biopsy: (178± 80) minutes vs. (198±42) minutes, t=-2.082, P=0.039; axillary lymph node dissection: (204±79) minutes vs. (233±49) minutes, t=-2.952, P=0.004), the volume of drainage in three days postoperative ((183±141)ml vs. (237±104) ml, t=- 2.938, P=0.004) in the open group were lower than endoscopic group. The volume of intraoperative blood loss in the endoscopic group was lower than that in the open group ((87±64) ml vs. (62± 36) ml, t=3.210, P=0.002). Patients' satisfaction of breast reconstruction in the endoscopic group was higher than that in the open group. Conclusions: Both endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery are safe in oncology. Endoscopic surgery maybe more suitable alternative in breast reconstruction for early-stage breast cancer patients.目的： 探讨腔镜与传统开放保留乳头乳晕的乳腺癌根治切除加一期假体植入乳房重建手术的疗效差异。方法： 回顾性分析2013年1月至2017年12月在陆军军医大学西南医院乳腺甲状腺外科住院行保留乳头乳晕的乳腺癌根治切除加一期假体植入乳房重建的189例早期乳腺癌患者的临床资料。按手术方式分为腔镜组104例，年龄（41.7±6.1）岁（范围：25~51岁），开放组85例，年龄（41.6±7.7）岁（范围：27~67岁）。采用t检验、Mann-Whitney U检验、χ(2)检验或Wilcoxon秩和检验比较两组的手术时间、术中出血量、术后3 d引流量、术后并发症发生率、患者对乳房重建的满意度等。结果： 两组术后并发症发生率、复发转移率和总体生存率差异无统计学意义（P>0.05）。开放组患者手术时间[前哨淋巴结活检：（178±80） min比（198±42） min，t=-2.082，P=0.039；腋窝淋巴结清扫：（204± 79） min比（233±49 ）min ，t=-2.952，P=0.004]、术后3 d引流量[（183±141 ）ml比（237±104）ml ，t=-2.938，P=0.004]低于腔镜组，术中出血量高于腔镜组[（87±64） ml比（62±36）ml ，t=3.210，P=0.002）。腔镜组患者对乳房重建满意度更高。结论： 腔镜和开放行保留乳头乳晕的乳腺癌切除加假体植入乳房重建术均安全有效。腔镜手术后患者满意度更高。.