Application of pectoralis major fascia in robotic nipple-sparing mastectomy immediate breast reconstruction with gel implant
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摘要:
目的 初步评估胸大肌筋膜在机器人保留乳头乳晕乳腺切除术即刻假体乳房重建（RNSMIBR）中应用的可行性、安全性及早期美学效果。 方法 该研究为回顾性队列研究。2023年11月—2025年4月,郑州大学第一附属医院收治34例符合入选标准的女性乳腺癌患者,将在RNSMIBR术中使用钛网补片扩大胸肌后平面容积的17例患者作为钛网补片组,年龄为（43±7）岁；将在RNSMIBR术中使用胸大肌筋膜扩大胸肌后平面容积的17例患者作为胸大肌筋膜组,年龄为（46±7）岁。统计术后住院期间及出院后30 d随访期间手术相关并发症发生情况,采用Clavien-Dindo分级评估发生的手术相关并发症；术后3个月左右随访时,采用BREAST-Q量表评估患者对乳房外形满意度、心理社会健康及对医疗服务的满意度。 结果 术后住院期间及出院后30 d随访期间,钛网补片组3例患者发生Ⅰ级并发症；胸大肌筋膜组3例患者发生Ⅰ级并发症,3例患者发生Ⅲb级并发症,发生Ⅲb级并发症中的1例患者为放射治疗所致；2组其余患者未发生手术相关并发症。2组患者发生的手术相关并发症Clavien-Dindo分级比较,差异无统计学意义（P>0.05）。术后3个月左右随访时,钛网补片组与胸大肌筋膜组患者BREAST-Q量表评分分别为（92±5）、（79±28）分,组间比较,差异无统计学意义（t=1.85,P>0.05）。 结论 胸大肌筋膜扩容技术可作为钛网补片难以获取或费用受限时行RNSMIBR的备选扩容方案；对需术后放射治疗患者,仍建议优先采用钛网补片等不依赖血供的材料以兼顾美学效果与并发症控制。 Abstract:Objective To preliminarily evaluate the feasibility, safety, and early aesthetic outcomes of using the pectoralis major fascia in robotic nipple-sparing mastectomy immediate breast reconstruction with gel implant (RNSMIBR). Methods This study was an retrospective cohort study. From November 2023 to April 2025, 34 female breast cancer patients who met the inclusion criteria and were treated at the First Affiliated Hospital of Zhengzhou University. Seventeen patients, aged 43±7 years, who underwent posterior subpectoral pocket expansion using a titanium mesh patch in RNSMIBR surgery were included into titanium mesh patch group, and 17 patients, age 46±7 years, who underwent posterior subpectoral pocket expansion using the pectoralis major fascia in RNSMIBR surgery were included into pectoralis major fascia group. Surgery-related complications during postoperative hospitalization and within 30 days after discharge were recorded and graded using the Clavien-Dindo classification. At the follow-up of approximately 3 months postoperatively, the BREAST-Q scale was used to score the patients' satisfaction with breast appearance, their psychosocial well-being, and satisfaction with medical care. Results During hospitalization and within 30 days after discharge, three patients in the titanium mesh patch group experienced grade I complications. In the pectoralis major fascia group, three patients experienced grade I complications and three patients experienced grade Ⅲb complications and the the grade Ⅲb complication in one patient was radiotherapy-related. No other complications occurred in the two groups. There was no statistically significant difference in the Clavien-Dindo classification of surgery-related complications between the two groups of patients (P>0.05). At the follow-up of approximately 3 months postoperatively, the BREAST-Q scale scores were 92±5 in the titanium mesh patch group of patients and 79±28 in the pectoralis major fascia group of patients, respectively, with no statistically significant difference between the two groups (t=1.85, P>0.05). Conclusions The pectoralis major fascia-assisted expansion may serve as an alternative option of expansion in RNSMIBR when titanium mesh patch is unavailable or cost-prohibitive. For patients requiring postoperative radiotherapy, titanium mesh patch or other materials that do not rely on vascular supply are still preferred to balance aesthetic outcomes and complication control. -
参考文献
(40) [1] 国际机器人乳腺外科手术专家协作组(专家委员会).机器人乳腺癌手术专家共识[J/CD].中华乳腺病杂志(电子版),2024,18(3):129-139.DOI: 10.3877/cma.j.issn.1674-0807.2024.03.001. [2] 中国抗癌协会乳腺癌专业委员会,中华医学会肿瘤学分会乳腺肿瘤学组,邵志敏.中国抗癌协会乳腺癌诊治指南与规范(2024年版)[J].中国癌症杂志,2023,33(12):1092-1186.DOI: 10.19401/j.cnki.1007-3639.2023.12.004. [3] 袁莹,周敏,漆白文,等.腹壁上动脉穿支筋膜皮瓣修复乳腺恶性肿瘤术后胸壁巨大创面的临床效果[J].中华烧伤与创面修复杂志,2025,41(9):895-901.DOI: 10.3760/cma.j.cn501225-20240930-00367. [4] 陈阔,吕鹏威.达芬奇机器人保留乳头乳晕的乳腺切除即刻假体乳房重建术的学习曲线研究[J].中国现代普通外科进展,2024,27(11):873-876.DOI: 10.3969/j.issn.1009-9905.2024.11.007. [5] 刘军,王子函,沈光前,等.单孔机器人乳房胸肌前重建手术的技术要点与重要改进[J].国际外科学杂志,2025,52(6):370-375.DOI: 10.3760/cma.j.cn115396-20250427-00115. [6] 刘跃,栾杰.机器人辅助手术技术在乳房再造中的应用进展[J].中华整形外科杂志,2022,38(12):1414-1418.DOI: 10.3760/cma.j.cn114453-20210812-00345. [7] 吴鑫,刘静,陈莉.机器人手术系统在乳腺外科的应用进展[J].机器人外科学杂志(中英文),2023,4(3):186-192.DOI: 10.12180/j.issn.2096-7721.2023.03.002. [8] 孙黎明,宋保强.内窥镜辅助下切取广泛背阔肌及脂肪填充进行供区无瘢痕的乳房重建[J].中华烧伤与创面修复杂志,2023,39(9):812.DOI: 10.3760/cma.j.issn.2097-1109.2023.09.101. [9] YuDY,LeeHY,LeeTY,et al.Endoscopic mastectomy: a cost-effective and time-efficient alternative to robotic mastectomy with comparable oncologic and safety outcomes[J].J Breast Cancer,2025,28(5):347-357.DOI: 10.4048/jbc.2025.0090. [10] ChenWF, CheongDCF, Tedone ClementeE, et al. Robot-assisted lymph node-to-vein anastomosis: lessons from the first 22 cases at a high-volume lymphatic supermicrosurgery center[J]. Curr Oncol, 2025, 32(7):377. DOI: 10.3390/curroncol32070377. [11] LaiHW,ToescaA,SarfatiB,et al.Consensus Statement on Robotic Mastectomy-Expert Panel From International Endoscopic and Robotic Breast Surgery Symposium (IERBS) 2019[J].Ann Surg,2020,271(6):1005-1012.DOI: 10.1097/SLA.0000000000003789. [12] 陈阔,吕鹏威.机器人辅助乳腺手术应用现状与发展趋势[J].中国实用外科杂志,2024,44(11):1317-1320.DOI: 10.19538/j.cjps.issn1005-2208.2024.11.25. [13] ToescaA,ParkHS,RyuJM,et al.Robot-assisted mastectomy: next major advance in breast cancer surgery[J].Br J Surg,2023,110(4):502-503.DOI: 10.1093/bjs/znad006. [14] 陈阔,吕鹏威.达芬奇机器人辅助聚丙烯酰胺水凝胶注射物取出即刻行假体乳房再造[J].中国美容医学,2025,34(1):49-52. [15] WangQ,YangQ,ChenZ,et al.Robot assisted sentinel lymph node biopsy using indocyanine green combined with carbon nanoparticles staining improved detection rates in breast cancer[J].Sci Rep,2025,15(1):21366.DOI: 10.1038/s41598-025-06338-6. [16] KimCW,YooTK,KimJ,et al.Postoperative outcomes of single-port robot-assisted versus conventional nipple-sparing mastectomy with immediate reconstruction[J].Ann Surg Oncol,2025.DOI: 10.1245/s10434-025-18733-4. [17] 陈阔,吕鹏威.机器人辅助乳腺切除术治疗男性乳腺发育的临床应用价值分析(附手术视频)[J].机器人外科学杂志(中英文),2025,6(8):1354-1358.DOI: 10.12180/j.issn.2096-7721.2025.08.020. [18] 陈阔,吕鹏威.机器人与传统乳腺癌保留乳头乳晕皮下腺体切除即刻假体乳房重建术疗效对比研究[J].中国实用外科杂志,2024,44(11):1276-1280,1285.DOI: 10.19538/j.cjps.issn1005-2208.2024.11.17. [19] ChenK,ZhangJ,BeerakaNM,et al.Robot-assisted nipple-sparing mastectomy and immediate breast reconstruction with gel implant and latissimus dorsi muscle flap: Our initial experience[J].Int J Med Robot,2023,19(5):e2528.DOI: 10.1002/rcs.2528. [20] RyuJM, KimJY, ChoiHJ, et al. Robot-assisted nipple-sparing mastectomy with immediate breast reconstruction: an initial experience of the Korea Robot-endoscopy Minimal Access Breast Surgery Study Group (KoREa-BSG) [J]. Ann Surg, 2022, 275(5): 985-991. DOI: 10.1097/SLA.0000000000004492. [21] 尹安思,吴斌,权毅,等.带蒂肋间前动脉穿支皮瓣在乳腺癌保乳术后乳房重建中的临床应用效果[J].中华烧伤与创面修复杂志,2025,41(7):680-687.DOI: 10.3760/cma.j.cn501225-20240625-00249. [22] LeeMJ,WonJ,SongSY,et al.Clinical outcomes following robotic versus conventional DIEP flap in breast reconstruction: a retrospective matched study[J].Front Oncol,2022,12:989231.DOI: 10.3389/fonc.2022.989231. [23] 陈阔,吕鹏威.不同端口机器人保留乳头乳晕的乳房切除即刻乳房重建对比研究(附手术视频)[J].机器人外科学杂志(中英文),2025,6(10):1745-1749.DOI: 10.12180/j.issn.2096-7721.2025.10.022. [24] GundlapalliVS,OgunleyeAA,ScottK,et al.Robotic-assisted deep inferior epigastric artery perforator flap abdominal harvest for breast reconstruction: a case report[J].Microsurgery,2018,38(6):702-705.DOI: 10.1002/micr.30297. [25] ChenK,ZhangJ,BeerakaNM,et al.Robotic nipple sparing mastectomy and immediate breast reconstruction: significant attempts with the latissimus dorsi muscle without island flap[J].Minerva Surg,2024,79(4):411-418.DOI: 10.23736/S2724-5691.24.10244-4. [26] AngaritaFA,CasteloM,EnglesakisM,et al.Robot-assisted nipple-sparing mastectomy: systematic review[J].Br J Surg,2020,107(12):1580-1594.DOI: 10.1002/bjs.11837. [27] ManriqueOJ,BustosSS,MohanAT,et al.Robotic-assisted DIEP flap harvest for autologous breast reconstruction: a comparative feasibility study on a cadaveric model[J].J Reconstr Microsurg,2020,36(5):362-368.DOI: 10.1055/s-0040-1701666. [28] 陈阔,吕鹏威.达芬奇机器人辅助保留乳头乳晕乳腺切除即刻假体联合背阔肌组织瓣乳房重建的初步探索[J].组织工程与重建外科杂志,2024,20(5):522-527.DOI: 10.3969/j.issn.1673-0364.2024.05.004. [29] ClavienPA,BarkunJ,de OliveiraML,et al.The Clavien-Dindo classification of surgical complications: five-year experience[J].Ann Surg,2009,250(2):187-196.DOI: 10.1097/SLA.0b013e3181b13ca2. [30] AbbassiF,PfisterM,LucasKL,et al.Milestones in surgical complication reporting: clavien-dindo classification 20 years and comprehensive complication index 10 years[J].Ann Surg,2024,280(5):763-771.DOI: 10.1097/SLA.0000000000006471. [31] PusicAL,KlassenAF,ScottAM,et al.Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q[J].Plast Reconstr Surg,2009,124(2):345-353.DOI: 10.1097/PRS.0b013e3181aee807. [32] FarrDE,HaddockNT,TellezJ,et al.Safety and feasibility of single-port robotic-assisted nipple-sparing mastectomy[J].JAMA Surg,2024,159(3):269-276.DOI: 10.1001/jamasurg.2023.6999. [33] LiZ,ChenZ,WeiL,et al.Minimally invasive axillary lymph node dissection versus conventional axillary lymph node dissection: a comparative study on short-term efficacy in breast cancer[J].Surg Endosc,2025,39(8):4935-4945.DOI: 10.1007/s00464-025-11863-6. [34] ChenK, LuP. Study of learning curve for da Vinci robotic nipple sparing mastectomy and immediate breast reconstruction with Gel implant[J]. Asian J Surg, 2025, 48(6): 3537-3543. DOI: 10.1016/j.asjsur.2024.12.173. [35] 陈阔,吕鹏威.达芬奇机器人乳腺外科手术151例[J].中华普通外科杂志,2024,39(7):516-520.DOI: 10.3760/cma.j.cn113855-20240206-00115. [36] ParkHS,LeeJ,LaiHW,et al.Surgical and oncologic outcomes of robotic and conventional nipple-sparing mastectomy with immediate reconstruction: international multicenter pooled data analysis[J].Ann Surg Oncol,2022,29(11):6646-6657.DOI: 10.1245/s10434-022-11865-x. [37] 张晴,谢妍妍,梁法清,等.腔镜和机器人手术在乳腺疾病治疗中的前世今生[J].中国修复重建外科杂志,2024,38(7):769-775.DOI: 10.7507/1002-1892.202404034. [38] 宋达疆,李赞,周晓,等.双侧腹壁浅动脉穿支皮瓣移植再造1例单侧乳腺癌患者乳房[J].中华烧伤与创面修复杂志,2022,38(10):964-967.DOI: 10.3760/cma.j.cn501225-20220306-00047. [39] 杜伟力,沈余明,程琳,等.乳腺癌根治术后胸部放射性溃疡的修复策略及其临床效果[J].中华烧伤与创面修复杂志,2024,40(06):521-528.DOI: 10.3760/cma.j.cn501225-20240315-00099. [40] 陶齐,王合丽,陈雷,等.人脱细胞真皮基质在乳房切除术后即刻乳房重建术中应用的研究进展[J/CD].中华损伤与修复杂志:电子版, 2021, 16(2):6.DOI: 10.3877/cma.j.issn.1673-9450.2021.02.011. -
图 1 机器人保留乳头乳晕乳腺切除手术。1A.切口处安装单孔切口保护套；1B.在胸大肌下缘皱襞处将胸大肌离断；1C.沿腺体表面大颗粒脂肪中间平面游离乳腺皮瓣至腺体边缘；1D.切取乳头下方组织进行活检
图 2 钛网补片在例1患者机器人保留乳头乳晕乳腺切除术即刻假体乳房重建中的应用效果。2A.术前右侧位；2B.术前正位；2C.术前左侧位；2D.术中将倒刺线送入；2E.术中借助机器人器械将钛网补片的短边缝合固定于胸大肌断端；2F.术中将补片下部向内翻折,平铺于胸大肌后间隙；2G.术后3个月右侧位；2H.术后3个月正位；2I.术后3个月左侧位
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