探讨经腋窝腔镜辅助保留乳头乳晕皮下腺体切除术+I期胸肌前假体乳房重建术的可行性及临床应用价值。

回顾性分析2022年1月至12月接受经腋窝腔镜辅助保留乳头乳晕皮下腺体切除术+Ⅰ期胸肌前假体乳房重建术的32例女性乳腺癌患者的临床资料。数据应用SPSS 22.0统计学软件分析。围手术期各项指标、Breast-Q 量表、Scar-Q量表等计量资料以（）表示，组内比较采用配对样本 t 检验；术后并发症等计数资料以[例（%）]表示，采用χ²检验。P<0.05为差异有统计学意义。

32例患者均顺利完成经腋窝腔镜辅助保留乳头乳晕皮下腺体切除术+Ⅰ期胸肌前假体乳房重建术，手术时间为（138.5±20.7）min，术中失血量为（49.6±24.3）ml，前哨淋巴结数为（3.0±1.0）枚，术区引流时间为（7.3±1.5）d，术区总引流量为（504.8±19.6）ml，术后住院时间为（6.3±1.2）d，且所有患者术后病理标本的切缘均为阴性。术后美容效果评价优良率为93.8%（30/32），Breast-Q评分结果显示，术后1个月及3个月胸壁状态、性生活、社会心理状态的评分与术前比较，差异有统计学意义（P<0.05）；Scar-Q评分结果显示，术后疤痕外观满意度随时间逐渐升高，术后6个月评分升高至（66.1±6.2）分。术后出现假体移位1例（3.1%），皮下积液2例（6.3%），皮瓣局部性坏死2例（6.3%），但无切口感染、切口裂开、术后出血、胸壁疼痛、包膜挛缩等并发症的发生，且随访期间内所有患者均未出现局部复发、远处转移及死亡等事件。

经腋窝腔镜辅助保留乳头乳晕皮下腺体切除术+Ⅰ期胸肌前假体乳房重建术安全可行，并获得了较好的根治效果、美容效果和满意度，可于临床广泛推广应用。

To investigate the feasibility and clinical value of transaxillary endoscopic assisted subcutaneous glandectomy with nipple and areolar preservation plus breast reconstruction with anterior breast prosthesis at stage Ⅰ.

The clinical data of 32 women with breast cancer who underwent transaxillary endoscopic assisted papillary areolar subcutaneous glandectomy plus stageⅠbreast reconstruction with breast prosthesis were retrospectively analyzed from January to December 2022. SPSS 22.0 statistical software was used to analyze the data. Perioperative indicators, Breast-Q scale, Scar-Q scale and other measurement data were represented by (). Paired sample t test was used for intra-group comparison. The statistical data of postoperative complications were shown as [cases (%)] and χ² test was used. P < 0.05 was considered statistically significant.

All 32 patients successfully completed the axillary endoscopic assisted subcutaneous gland resection with preserving nipple and areolae plus stageⅠbreast prosthesis reconstruction. The operation time was (138.5±20.7) min, the intraoperative blood loss was (49.6±24.3) ml, and the number of sentinel lymph nodes was (3.0±1.0). The drainage time of the operative area was (7.3±1.5) d, the total drainage volume of the operative area was (504.8±19.6) ml, and the postoperative hospital stay was (6.3±1.2) d, and the incision margin of the postoperative pathological specimens of all patients were negative. The excellent and good rate of postoperative cosmetic effect evaluation was 93.8% (30/32). The results of Breast-Q score showed that the scores of chest wall status, sexual life and social psychological status at 1 and 3 months after surgery had statistical significance compared with those before surgery (P<0.05). The results of SCAR-Q score showed that the satisfaction of Scar appearance gradually increased with time, and the score increased to (66.1±6.2) points 6 months after surgery. Prosthesis displacement occurred in 1 case (3.1%), subcutaneous effusion in 2 cases (6.3%), and local necrosis of skin flap in 2 cases (6.3%), but there were no complications such as incision infection, incision dehiscence, postoperative bleeding, chest wall pain, capsular contracture, etc., and no local recurrence, distant metastasis, or death occurred in all patients during follow-up.

Axillary endoscopic assisted subcutaneous gland resection with nipple and areolar preservation + breast reconstruction with anterior breast prosthesis in stageⅠis safe and feasible, and has obtained good radical, cosmetic and satisfactory results, which can be widely used in clinical practice.