腋下单切口充气腔镜保乳联合迷你背阔肌手术与传统保乳手术效果比较

程陆洋; 刘莉; 关洁芳; 赖杨素; 刘立汉; 张宏都

doi:10.3971/j.issn.1000-8578.2025.25.0096

腋下单切口充气腔镜保乳联合迷你背阔肌手术与传统保乳手术效果比较

Effects of Axillary Single-Port Incision Insufflation Endoscopic Breast-Conserving Surgery with Mini Latissimus Dorsi Surgery Versus Conventional Breast-Conserving Surgery

摘要

摘要:
目的比较传统保乳手术与腋下单切口充气腔镜保乳联合迷你背阔肌（单切口腔镜组）治疗早期乳腺癌的安全性、手术疗效和美学效果。
方法回顾性分析2021年1月至2024年6月甘肃中医药大学第三附属医院收治的62例早期乳腺癌女性患者临床资料。按术式分为传统组37例、腔镜组25例，比较两组患者临床基线资料、手术结果、术后效果。
结果临床基线资料中，由于腔镜组扩大了保乳适应证，肿瘤最大径和肿瘤/乳房体积比均高于传统组（P<0.001），余指标差异均无统计学意义（P>0.05）。与传统组相比，腔镜组切口总长度更短［3.40（3.15，3.60）cm vs. 7.30（6.50，7.60）cm，P<0.001］；术后引流量更少（206.20±35.11）ml vs. （223.95±26.17）ml，P=0.026，但手术时间更长（254.92±22.67）min vs.（146.78±13.01）min，P<0.001。腔镜组切缘阳性率为0%（0/25），显著低于传统组的10.8%（4/37），P=0.141。腔镜组并发症发生率较传统组低（4% vs.27%，P=0.047），术后6个月患者，参照日本乳腺癌协会美学评分优良率更高（76% vs. 43.2%，P=0.006）。
结论腋下单切口充气腔镜保乳联合迷你背阔肌手术的肿瘤学安全性（切缘阴性率）不劣于传统术式，且具有切口更隐蔽、并发症更少、美学效果更佳等优势，尤其适用于肿瘤位于外象限且乳房切除比>20%的中小乳房早期乳腺癌患者。

Abstract:
Objective To compare the oncologic safety, surgical efficacy, and aesthetic outcomes between conventional breast-conserving surgery and axillary single-port incision insufflation endoscopic breast-conserving surgery with mini-latissimus dorsi surgery in early breast cancer patients.
Methods A retrospective analysis of clinical data from 62 female patients with early breast cancer was performed. Patients were divided into two groups on the basis of surgical method: the conventional group (37 cases) and the endoscopic group (25 cases).The clinical baseline data, surgical results, and postoperative effects of the two groups were compared.
Results According to the clinical baseline data, the endoscopic group had a greater maximum tumor diameter and a greater tumor-to-breast volume ratio due to expanded indications for breast-conserving surgery (P<0.001), whereas the other data revealed no statistically significant difference between the two groups (P>0.05). Compared with those in the conventional group, the total incision length in the endoscopic group was shorter 3.40(3.15, 3.60) cm vs. 7.30 (6.50, 7.60) cm, P<0.001, the postoperative drainage volume was lower (206.20±35.11 ml vs. 223.95±26.17 ml, P=0.026), but the operative time was longer (254.92±22.67 min vs. 146.78±13.01 min, P<0.001). The incision margin positive rate was 0% (0/25) in the endoscopic group, which was significantly lower than the 10.8% (4/37) in the conventional group (P=0.141). The endoscopic group had a lower incidence of complications (4% vs. 27%, P=0.047) and superior JBCS aesthetic scores at the 6-month follow-up (76% vs. 43.2%, P=0.006).
Conclusion Axillary single-port incision insufflation endoscopic breast-conserving surgery with mini-latissimus dorsi surgery is not inferior to conventional procedures in terms of oncologic safety (margin-negative rate) and offers advantages in terms of scar concealment, fewer complications, and better aesthetic outcomes, especially suitable for early breast cancer patients with small-to-medium breast volumes, tumors located in the outer quadrants and mastectomy ratios of >20%.

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