目的 探讨达芬奇机器人保留乳头乳晕乳腺切除即刻假体乳房重建术(robotic nipple-sparing mastectomy and immediate breast reconstruction,R-NSM-IBR)中预防热蒸汽损伤皮肤组织的方法.方法 回顾性分析2022年9月-2023年12月接受R-NSM-IBR治疗且符合选择标准的128例乳腺癌女性患者临床资料.术中乳腺切除期间,99例采用覆盖冰水冷却后纱布来降低乳房皮肤温度(A组),29例不作处理(B组).两组患者年龄、手术侧别、身体质量指数、乳腺癌病理类型及接受辅助化疗、新辅助化疗构成比比较,差异均无统计学意义(P＞0.05).记录并比较术中乳房表面温度、单侧乳腺切除时间以及术中乳房热损伤并发症发生情况.结果 A、B组单侧乳腺切除时间分别为(77.18±9.23)、(76.38±12.88)min,差异有统计学意义(P＜0.05).A组术中乳房表面温度为(25.61±0.91)℃,低于B组(33.38±1.14)℃,差异亦有统计学意义(P＜0.05).术中7例发生皮肤热损伤,其中A组2例(2.0％)、B组5例(17.2％),发生率差异有统计学意义(P＜0.05).其中,B组1例水庖破裂并感染,最终导致假体取出;其余患者均干预处理后恢复正常.结论 R-NSM-IBR术中采用在乳房表面覆盖冰水冷却后纱布降温方法可有效降低热蒸汽损伤皮肤的风险.
Study of heat steam induced skin damage prevention in robotic nipple-sparing mastectomy and immediate breast reconstruction using Da Vinci Robot
Objective To explore the method of preventing heat steam induced skin damage in robotic nipple-sparing mastectomy and immediate breast reconstruction(R-NSM-IBR)using Da Vinci Robots.Methods A clinical data of 128 female patients with breast cancer,who were treated with R-NSM-IBR between September 2022 and December 2023 and met the selection criteria,was retrospectively analyzed.During robotic nipple-sparing mastectomy,the breasts were covered with gauze cooled by ice water to reduce skin temperature in 99 cases(group A)and were not treated in 29 cases(group B).There was no significant difference in the age,affected side,body mass index,pathological type of breast cancer,and constituent ratios of adjuvant chemotherapy and neoadjuvant chemotherapy between the two groups(P＞0.05).Intraoperative breast skin temperature,unilateral robotic nipple-sparing mastectomy time,and the incidence of complications of breast heat steam induced skin damage were recorded.Results The time for unilateral robotic nipple-sparing mastectomy was(77.18±9.23)minutes in group A and(76.38±12.88)minutes in group B,with significant difference between the two groups(P＜0.05).The intraoperative breast skin temperature was significantly lower in group A than in group B[(25.61±0.91)℃ vs(33.38±1.14)℃;P＜0.05].Seven cases of heat steam skin damage occurred during operation,including 2 cases(2.0％)in group A and 5 cases(17.2％)in group B,with a significant difference in incidence between the two groups(P＜0.05).Among them,1 patient in group B had a vesication rupture and infection,which eventually led to the removal of the implant;the rest of the patients were treated with postoperative interventions for skin recovery.Conclusion The use of breast covered with gauze cooled by ice water during R-NSM-IBR can effectively reduce the risk of heat steam induced skin damage.
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