带蒂胸外侧动脉穿支皮瓣与乳房成形术在早期乳腺癌保乳整形中的应用效果比较

Comparison of pedicled lateral thoracic artery perforator flap and mammoplasty in oncoplastic breast-conserving surgery for early-stage breast cancer

摘要:

背景与目的 保乳整形术（OBCS）结合了肿瘤外科与整形外科理念，主要包括容积移位与容积替代两种手术方式。带蒂胸外侧动脉穿支（LTAP）皮瓣是容积替代中常用的一种技术，国内已有研究证实其在OBCS中的安全性，但其患者报告结局尚缺乏系统评价，与容积移位在OBCS中的临床效果的对比也未见报道。因此，本研究比较带蒂LTAP皮瓣和乳房成形术（容积移位）在OBCS中的临床应用效果及患者满意度，为术式选择提供依据。方法 采用回顾性病例对照研究，纳入2023年1月—2024年6月在西南医科大学附属医院乳腺外科接受OBCS治疗的106例单侧0~Ⅲ期乳腺癌患者。根据术式分为带蒂LTAP皮瓣组（27例）和乳房成形组（79例）。比较两组在术中参数、美容结局、术后并发症及术前后Breast-Q评分等方面的差异。结果 两组患者的临床病理特征及术前Breast-Q评分差异均无统计学意义（均P>0.05）。带蒂LTAP皮瓣组手术时间更长、切除组织体积更大、术后引流量更多（均P<0.001）。LTAP组术后美容结局优良率（88.9% vs. 57.3%）及乳房满意度、社会心理健康、躯体健康等Breast-Q评分维度均优于乳房成形组（均P<0.05）。两组术后并发症发生率及局部复发率差异无统计学意义（均P>0.05）。结论 在OBCS中，带蒂LTAP皮瓣不仅具备与乳房成形术相当的安全性，还能在美容效果和患者满意度方面取得更佳结果，适用于乳房体积较小但切除范围较大的患者，具有良好的临床推广价值。

Abstract:

Background and Aims Oncoplastic breast-conserving surgery (OBCS) integrates oncologic and plastic surgical techniques and includes two primary approaches: volume displacement and volume replacement. The pedicled lateral thoracic artery perforator (LTAP) flap is a commonly used technique for volume replacement. Although recent studies in China have confirmed its safety in OBCS, its patient-reported outcomes have not been systematically evaluated, and comparative data with volume displacement techniques remain lacking. Therefore, this study was performed to compare the clinical outcomes and patient satisfaction of LTAP flap versus mammoplasty (volume displacement) in OBCS, to inform surgical decision-making.Methods A retrospective case-control study was conducted, including 106 patients with unilateral stage 0-Ⅲ breast cancer who underwent OBCS at the Affiliated Hospital of Southwest Medical University from January 2023 to June 2024. Patients were divided into the LTAP flap group (27 cases) and the mammoplasty group (79 cases) based on the surgical technique. Intraoperative variables, cosmetic outcomes, postoperative complications, and Breast-Q scores before and after surgery were compared between the two groups.Results There were no significant differences between the two groups in clinicopathological characteristics or preoperative Breast-Q scores (all P>0.05). The LTAP group had longer operative times, larger excised tissue volumes, and greater postoperative drainage volumes (all P<0.001). Postoperative cosmetic outcomes were significantly better in the LTAP group, with a higher rate of excellent-to-good cosmetic results (88.9% vs. 57.3%) and higher Breast-Q scores in breast satisfaction, psychosocial well-being, and physical well-being (all P<0.05). There were no significant differences in complication rates or local recurrence between the two groups (all P>0.05).Conclusion In OBCS, the LTAP flap demonstrates comparable safety to mammoplasty while achieving superior cosmetic outcomes and patient satisfaction. It is particularly suitable for patients with small breast volumes requiring large tissue excision and holds promise for broader clinical application.