机器人辅助保留乳头乳晕的皮下腺体切除术后乳房重建的临床研究

摘要/Abstract

目的：探讨机器人辅助保留乳头乳晕的皮下腺体切除后乳房重建的最新进展。方法：进行一项系统的搜索策略，输入关键词：机器人手术（Robotic mastectomy or robotic surgery）、保留乳头乳晕复合体乳房切除术（Nipple-sparing mastectomy）、乳房重建术（Breast reconstruction）；应用在线数据库：Medline、Embase、Scopus、Web of science、Pubmed、中国知网等，纳入符合条件的论著进行分析。结果：共检出相关文献 43 篇，符合标准的论著 8 项。对 242 例患者实施了 302 个手术，含治疗性和预防性手术。其中一期植入物（假体）256 例，二期植入物（假体）8 例，植入假体占总手术的 87.4%；扩张器植入 19 例（6.3%，拟行二期乳房重建），一期背阔肌皮瓣乳房重建 25 例（8.3%），其中包含背阔肌同时联合假体 6 例。总体并发症发生率为 15.9%，局部复发率约为 1%，远处转移率为 0。随访期间除 1 例在术前有骨转移死亡外，总生存率为 100%。平均学习曲线为 12 例。患者满意度总体评价满意，术后生活质量良好。结论：机器人辅助保留乳头乳晕的皮下腺体切除后乳房重建术安全、有效，值得推广。

Objective: To investigate the safety and progress of robot-assisted nipple-sparing mastectomy with immediate breast reconstruction. Methods: A systematic search strategy was established. Keywords such as Robotic Mastectomy or Robotic surgery, Nipple-sparing mastectomy (NSM), Breast reconstruction were input into online databases for searching, including Medline, Embase, Scopus, Web of Science, Pubmed, China HowNet, etc. Results: A total of 43 related literatures were screened out and 8 papers met the standards of this study. A total of 302 surgeries, both therapeutic and preventive, were performed on 242 patients. Among them, 256 cases (87.4%) were given phase I implants and 8 cases had phase II implants. 19 cases (6.3%) had expander and Secondary breast reconstruction. 25 cases (8.3%) were given phase I breast reconstruction with latissimus dorsi flap, including 6 cases of latissimus dorsi flap combined with prosthesis. The overall complication rate across all the studies was 15.9%, with the local recurrence rate of about 1% and distant transfer rate of 0. The overall survival rate was 100% during follow-up, except for 1 cases of preoperative death with bone metastases. The average learning curve was 12 cases. The overall evaluation of patient satisfaction was satisfactory and postoperative life quality was good. Conclusion: Robot-assisted nipplesparing mastectomy with immediate breast reconstruction is safe, effective and worth clinical promotion.

稿件信息

参考文献

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