Objective: To discuss the surgical treatment and efficacy of endoscopic nipple-sparing mastectomy with skin lifting system (ENSMSLS) followed by immediate breast reconstruction. Methods: ENSMSLS was conducted on 21 patients followed by immediate breast reconstruction with implant via axillary incision from August 2014 to January 2016 in Oncology Center, Beijing Tongren Hospital, Capital Medical University. These 21 patients were frequency matched with 21 patients, who received nipple-sparing mastectomy via loop periareolar incision from November 2012 to May 2015 in the same center. These 21 patients formed the control group. The operation data of two groups were compared by t test and Fisher's exact test. Results: Differences in operation time ((185±43) minutes vs. (165±33) minutes, t=1.778, P=0.101), amount of bleeding ((60±48) ml vs. (75±57) ml, t=-0.535, P=0.329), and drainage ((240±112) ml vs. (201±91) ml, t=1.238, P=0.233) between these two groups of patients were not statistically significant. There was no nipple necrosis recorded in the ENSMSLS group, while there were three cases (14.3%) recorded in the control group. Two cases (9.5%) of nipple transposition were recorded in the ENSMSLS group, while five cases (23.8%) were recorded in the control group. Differences in nipple necrosis and nipple transposition were statistically significant (0 vs. 5, P=0.001). There were 16 cases (76.2%) of excellent appearance recorded in the ENSMSLS group, while there were 11 cases (52.4%) recorded in the control group. There were 5 cases (23.8%) of good appearance recorded in the ENSMSLS group, while there were 9 cases (42.9%) recorded in the control group. There was no case of fair appearance in the ENSMSLS group, while there was 1 case (4.8%) recorded in the control group. Difference in postoperative appearance was statistically significant (P=0.001). Conclusions: ENSMSLS significantly decreases the possibility of nipple necrosis and nipple transposition. This technique avoids visible incisions of breast. It also enhances the aesthetic appeal of reconstructed breasts.
目的：探讨应用皮肤悬吊系统腔镜下保留乳头乳晕乳腺切除(ENSMSLS)即刻乳房重建的手术方法和治疗效果。 方法： 2014年8月至2016年1月首都医科大学附属北京同仁医院肿瘤中心共为21例患者施行经腋下单一切口完成ENSMSLS即刻假体植入乳房重建(研究组)，患者均为女性，年龄33～60岁，平均年龄(44±9)岁。选择2012年11月至2015年5月于同一医院接受环乳晕切口、保留乳头乳晕乳腺切除即刻假体植入乳房重建患者21例(对照组)与研究组进行逐一配对研究。采用t检验和Fisher确切概率法比较两组的手术资料。 结果：两组间手术时间[(185±43)min比(165±33)min，t＝1.778，P＝0.101]、术中出血量[(60±48)ml比(75±57)ml，t＝－0.535，P＝0.329]、引流量[(240±112)ml比(201±91)ml，t＝1.238，P＝0.233]差异无统计学意义。两组间乳头相关并发症差异有统计学意义(乳头坏死：0例比3例，乳头移位：2例比5例，P＝0.001)。两组间乳房重建外观评价差异有统计学意义(优：16例比11例，良：5例比9例，一般：0例比1例，P＝0.001)。 结论：与采用环乳晕切口入路的直视下手术比较，ENSMSLS即刻乳房重建可以避免乳房表面切口，降低乳头坏死的发生，减少术后乳头移位，增加乳腺癌术后重建乳房的美学效果。.
Keywords: Breast neoplasms; Immediate breast reconstruction; Laparoscopy; Mastectomy.