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目的探讨影响乳腺癌手术保持乳头外形的因素及应注意的问题。方法选择乳腺癌患者实行保乳手术26例,术后从双乳头水平差距、乳头外形、胸骨中线与两侧乳头水平距离的差值以及疤痕对乳房外形影响4个方面,对保留乳房的外形美观效果进行评估。4项指标量化评估标准为得分≥14分为优,8~13分为良,<7分为差。结果术后评估乳房外形优良者22例,占84.62%,乳房外形较差者5例,占19.23%。其中乳头不自然挺立2例,占7.69%,切口疤痕致乳房畸形1例,占3.85%,与对侧乳头水平高度差距明显1例,占3.85%,乳头歪斜1例,占3.85%,为影响乳腺癌乳头外形手术的术后常见问题。结论术前手术切口的设计,术后切口包扎注意避免压迫乳头、切除乳腺组织的量、术中皮瓣的厚薄、保留乳腺组织的切除、缝合技巧均是保持术后乳房良好外形的重要因素。
Objective To explore the factors that affect the shape of nipple in breast cancer surgery and pay attention to it. Methods Breast cancer patients underwent breast-conserving surgery in 26 cases. The appearance of the preserved breasts was observed from 4 aspects: the difference of the level of the double-nipple, the shape of the nipple, the difference of the horizontal distance between the midline of the sternum and the bilateral nipples and the shape of the scar The effect is evaluated. Four indicators of quantitative evaluation criteria for the score ≥ 14 divided into excellent, 8 to 13 points for the good, <7 points for the poor. Results Postoperatively, 22 cases with excellent breast shape, accounting for 84.62%, had poor breast shape in 5 cases (19.23%). Among them, the nipple did not stand up naturally in 2 cases, accounting for 7.69%. There were 1 case (3.85%) of scar deformity caused by scar incision, which was significantly different from that of contralateral nipple in 1 case (3.85%) and nipple skewed in 1 case (3.85% Postoperative common problems in breast cancer nipple surgery. Conclusions Preoperative surgical incision design, postoperative incision to avoid pressure nipple oppression, removal of breast tissue volume, intraoperative flap thickness, retention of breast tissue resection, suture techniques are important factors to maintain a good shape of postoperative breast.