对比分析保留乳头的乳腺癌切除术(NSM)及传统乳腺癌根治术(CM)在早期乳腺癌患者中临床效果及近远期疗效。

纳入2012年1月至2014年3月收治的76例早期乳腺癌患者资料进行回顾性分析，根据术式不同分为NSM组(n＝42)和CM组(n＝34)。采用统计软件SPSS 20.0进行分析，年龄、肿瘤大小等采用均数±标准差表示，独立t检验；术后并发症、美学评估等计数资料采用卡方检验。采用Kaplan－Meier进行生存分析，利用log－rank检验，评估5年预后生存情况。P<0.05差异有统计学意义。

NSM组38例接受Ⅰ期乳房重建，4例接受Ⅱ期乳房重建；CM组仅3例接受Ⅱ期乳房重建。NSM组术后发生组织缺血坏死率大于CM组(P<0.05)，但两组术后并发症总发生率差异无统计学意义(P>0.05)。术后3个月NSM组乳房重建美观度优良率90.5%高于CM组79.4%(P<0.05)；术后5年两组局部复发率(7.1% vs. 5.9%)、无病生存率(83.3% vs.82.4% )，总生存率(90.5% vs.91.2% )，差异无统计学意义(P>0.05)。

较CM术相比，NSM在早期乳腺癌的治疗中同样具有安全性，且术中保留乳头乳晕复合体并不会增加其术后局部复发的风险，两组5年预后差异无统计学意义。

To compare both short-term and long-term clinical outcome of nipple sparing mastectomy (NSM) and conventional radical mastectomy (CM) in treating patients with early staging breast cancer.

The clinical data of 76 patients with early staging breast cancer from January 2012 to March 2014 were analyzed retrospectively, who were divided into NSM group (n=42) and CM group (n=34) according to different surgical methods. Statistical analysis were performed by using SPSS 20.0 software. Measurement data such as age and tumor size were represented as (±s) and were examined by using independent t test. Postoperative complications and aesthetic evaluation were analyzed by usingχ² test. Kaplan-meier method was used for survival analysis. Log-rank test was used to evaluate the 5-year prognosis. A P value of <0.05 was considered as statistical significant difference.

There were 38 patients in NSM group received one-stage breast reconstruction, and other 4 cases received two-stage breast reconstruction. However, there were only 3 cases received two-stage breast reconstruction. The postoperative ischemic necrosis rate in NSM group was higher than that in CM group (P<0.05), but there was no significant difference of overall incidence of postoperative complications between two groups (P>0.05). The "good" to "very good" rate of breast reconstruction aesthetics in NSM group was 90.5% higher than 79.4% in CM group 3 months after surgery (P<0.05). There was no significant difference in terms of local recurrence rate (7.1% vs. 5.9%), DFS(83.3% vs.82.4%) and OS(90.5% vs.91.2%) between two groups 5 years after surgery (P>0.05).

Compared with CM surgery, NSM is a safe therapeutic treatment for early staging breast cancer, and intraoperative retention of nipple and areola complex would not increase the risk of local recurrence after surgery. The 5-year prognosis of the two groups is similar.