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乳腺疾病严重影响女性的身心健康,近年来,乳腺的良性肿瘤和恶性肿瘤发病率不断上升,其中乳腺良性肿瘤约占乳腺肿瘤的80%,临床以乳腺纤维瘤、乳腺腺病、乳腺囊性增生、乳管内乳头状瘤较为常见[1]。另外有报道[2]显示我国乳腺恶性肿瘤病人每年死亡的人数高达5万人以上,且这一数字还在不断增长。一般良性无症状的肿块可保守观察并定期随访,但如果病人出现疼痛、焦虑、乳房外观改变,怀疑恶性时则需要手术治疗[3]。手术切除肿块是治疗乳腺良性肿瘤的首选方法[4]。传统的手术方法是根据肿瘤的位置做放射状切口,尽量减少对乳管的损伤,但术后易形成瘢痕,会给病人带来心理压力,甚至影响病人生活质量。随着人们生活水平和审美观念的不断提高,病人要求在手术治愈乳腺疾病的同时,还要保持乳房术后的美学效果[5]。因此在乳腺肿瘤切除选择手术方式时要考虑减少术后瘢痕和保持乳房外形。本研究采用了乳晕旁切口结合整形技术的手术方式与传统手术方式进行比较,在治疗疾病的同时保证了乳房的外形美观,病人满意度提高。现作报道。
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2组病人均手术顺利,术后切除肿物病理检查均为良性病变。观察组切口长度明显小于对照组(P < 0.01);2组手术时间、术中出血量和切口愈合时间差异均无统计学意义(P>0.05)(见表 1)。术后2组病人各1例切口积液感染,经换药后愈合。
分组 n 手术时间/min 术中出血量/mL 切口长度/cm 切口愈合时间/d 观察组 30 37.65± 8.94 20.13±3.42 3.23±0.48 6.44±1.63 对照组 30 36.80±8.26 21.45±2.17 5.82±0.61 6.81±1.35 t — 0.38 1.78 18.28 1.06 P — >0.05 >0.05 < 0.01 >0.05 表 1 2组病人手术情况比较(x±s)
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术后随访6个月,2组病人术后均无肿块复发,也无乳头凹陷发生。观察组无明显瘢痕增生,瘢痕的色泽、弹性均接近正常皮肤,观察组VSS评分明显优于对照组(P < 0.01)。通过问卷调查比较2病人对术后乳房外形满意度,结果显示,观察组病人满意度明显高于对照组(P < 0.01)(见表 2)。
分组 n VSS评分/分 满意度/% 观察组 30 4.45±2.86 29(96.67) 对照组 30 10.71±2.71 18(60.00) t — 8.70 11.88* P < — < 0.01 < 0.01 *示χ2值 表 2 2组病人术后VSS评分和乳房外形满意度比较(x±s)
乳晕旁切口结合整形治疗乳腺良性病变的临床疗效分析
Analysis of the clinical effect of paraareola incision combined with plastic surgery in the treatment of benign breast lesions
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摘要:
目的探讨乳晕旁切口结合整形治疗乳腺良性病变的临床疗效。 方法选取乳腺良性肿块病人60例,按手术入路不同分为2组,观察组30例采取乳晕旁切口结合整形技术治疗,对照组30例采取传统的放射状手术切口治疗。比较2组手术时间、术中出血量、切口长度、切口愈合情况及术后半年肿块复发率,以及切口瘢痕增生情况和病人对乳房外形满意度等。 结果2组病人均手术顺利,术后切除肿物病理检查均为良性病变。观察组切口长度明显小于对照组(P < 0.01);2组手术时间、术中出血量和切口愈合时间差异均无统计学意义(P>0.05)。术后随访6个月,2组病人术后均无肿块复发,亦无乳头凹陷发生。观察组病人术后切口温哥华瘢痕量表评分明显低于对照组(P < 0.01),术后对乳房外形满意度明显高于对照组(P < 0.01)。 结论与传统放射状切口相比,乳晕旁切口结合整形治疗乳腺良性病变具有切口隐蔽、切口小及术后乳房外形美观等优点,值得临床应用推广。 Abstract:ObjectiveTo investigate the clinical effects of paraareola incision combined with plastic surgery in the treatment of benign breast lesions. MethodsSixty patients with benign breast lesions were randomly divided into the observation group and control group according to different surgical approaches(30 cases in each group).The observation group was treated with paraareolar incision combined with plastic therapy, and the control group was treated with radial incision therapy.The duration of operation, intraoperative blood loss, incision healing, tumor recurrence rate within postoperative half a year, incision scar hyperplasia and patients' satisfaction with breast shape were compared between two groups. ResultsTwo groups were operated successfully, and the pathological examination of the tumor was benign.The incision length in observation group was significantly smaller than that in control group(P < 0.01).There was no statistical significance in the operation time, intraoperative blood loss and incision healing time between two groups(P>0.05).After 6 months of following-up, there was no tumor recurrence or nipple depression in two groups.The postoperative vancouver scar scale score in observation group was significantly lower than that in control group(P < 0.01), and the postoperative satisfaction with the breast shape in observation group was significantly higher than that in control group(P < 0.01). ConclusionCompared with the traditional radial incision, the para-areolar incision combined with plastic surgery in the treatment of benign breast lesions has the advantages of hidden incision, small trauma and beautiful breast appearance, which is worthy of clinical application and promotion. -
Key words:
- benign breast tumor /
- paraareolar incision /
- plastic therapy /
- radial incision
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表 1 2组病人手术情况比较(x±s)
分组 n 手术时间/min 术中出血量/mL 切口长度/cm 切口愈合时间/d 观察组 30 37.65± 8.94 20.13±3.42 3.23±0.48 6.44±1.63 对照组 30 36.80±8.26 21.45±2.17 5.82±0.61 6.81±1.35 t — 0.38 1.78 18.28 1.06 P — >0.05 >0.05 < 0.01 >0.05 表 2 2组病人术后VSS评分和乳房外形满意度比较(x±s)
分组 n VSS评分/分 满意度/% 观察组 30 4.45±2.86 29(96.67) 对照组 30 10.71±2.71 18(60.00) t — 8.70 11.88* P < — < 0.01 < 0.01 *示χ2值 -
[1] ELMORE JG, LONGTON GM, CARNEY PA, et al.Diagnostic concordance among pathologists interpreting breast biopsy specimens[J].JAMA, 2015, 313(11):1122. doi: 10.1001/jama.2015.1405 [2] CHEN W, ZHENG R, ZHANG S, et al.Annual report on status of cancer in China, 2010[J].Chin J Cancer Res, 2014, 26(1):48. [3] OH YJ, CHOI SH, CHUNG SY, et al.Spontaneously infarcted fibroadenoma mimicking breast cancer[J].Ultrasound Med, 2009, 28(10):1421. doi: 10.7863/jum.2009.28.10.1421 [4] DIXON JM, DOBIE V, LAMB J, et al.Assessment of the acceptability of conservative management of fibroadenoma of the breast[J].Br J Surg, 1996, 83(2):264. doi: 10.1002/bjs.1800830238 [5] KONG XN, CHEN XI, JIANG LY, et al.Periareolar incision for the management of benign breast tumors[J].Oncol Lett, 2016, 12(3):3259. [6] 张浩.环乳晕切口在乳腺癌保乳手术中的应用[J].中华实验外科杂志, 2013, 30(2):383. doi: 10.3760/cma.j.issn.1001-9030.2013.02.066 [7] ACHEBE JU, NJEZE GE, OKWESILI OR.Treatment of unilateral giant fifibroadenoma by breast reduction skin incision:The inverted "T" technique[J].Niger J Clin Pract, 2014, 17(1):43. doi: 10.4103/1119-3077.122835 [8] 孙晶晶, 栾杰, 穆大力, 等.中国女性假体隆乳术不同切口瘢痕的前瞻性对比研究[J].中华整形外科杂志, 2018, 34(2):101. doi: 10.3760/cma.j.issn.1009-4598.2018.02.006 [9] 任洪伟.美乳切口治疗乳房肿瘤效果对比及术后瘢痕程度分析[J/CD].中华普通外科学文献: 电子版, 2016, 10(1): 43. [10] LAPID O, KLINKENBIJL JH, OOMEN MW, et al.Gynaecomastia surgery in the Netherlands:What, why, who, where[J].J Plast Reconstr Aesthet Surg, 2014, 67(5):702. doi: 10.1016/j.bjps.2014.01.040 [11] ARACO A, ARACO F, SORGER R, et al.Sensitivity of the nipple-areola complex and areolar pain following aesthetic breast augmentation in a retrospective series of 1200 patients:periareolar versus submammary incision[J].Plast Reconstr Surg, 2011, 128(4):984. doi: 10.1097/PRS.0b013e3182268d73 [12] ZHANG ML, SHEN GJ, ZHANG S, et al.Advantages of the modifified double ring areolar incision over the traditional areolar incision in multicentric breast fifibroadenoma surgery[J].Thorac Cancer, 2017, 8(4):423. [13] LAI HW, LIN HY, CHEN SL, et al.Endoscopy-assisted surgery for the management of benign breast tumors:technique, learning curve, and patient reported outcome from preliminary 323 procedures[J].World J Surg Oncol, 2017, 19(15):111.