Objective:To explore the preventive value of "integrated prevention strategy" for nipple and areola ischemia after single-port endoscopic subcutaneous mastectomy.Methods:The clinical data of 72 patients with breast cancer who received single-port endoscopic subcutaneous mastectomy in Beijing Friendship Hospital, Capital Medical University from July 2019 to July 2021 were retrospectively analyzed, they were all female. The follow-up period was up to July 2022. According to the perioperative treatment methods, the patients were divided into observation group ( n=40) and control group ( n=32). The patients in the observation group who adopted the "integrated prevention strategy" scheme, and patients in the control group who adopted the conventional treatment scheme. The incidence of postoperative nipple and areola ischemic was compared between the two groups, and the postoperative cosmetic effect, quality of life and satisfaction of patients were evaluated. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; the Chi-square test was used to compare the data groups. Results:The postoperative drainage volume in the observation group was significantly lower than that in the control group [(632.40±226.37) mL vs (774.91±239.85) mL], and the difference was statistically significant ( P=0.013). Two weeks after operation, there was 1 case of nipple and areola ischemia in the observation group, and 7 cases in the control group, the difference was statistically significant between the two groups ( P=0.019). Twelve months after operation, the score of breast satisfaction (83.93±11.64 vs 67.28±11.52), chest satisfaction (89.63±8.06 vs 83.03±9.49) and psychosocial well-being (89.43±12.42 vs 78.88±10.40) in the observation group were better than those in the control group, the differences were statistically significant ( P<0.05). Conclusion:"Integrated prevention strategy" can effectively prevent the occurrence of nipple and areola ischemic after single-port endoscopic subcutaneous mastectomy and improve patient satisfaction, which has certain promotion value.

Objective:To explore the significance of exposing the circummammary ligament under endoscopy and the effect of membrane anatomy in breast reconstruction.Methods:The case data of 49 breast cancer patients who underwent endoscopic nipple-sparing mastectomy combined with one-stage breast reconstruction with prosthesis implantation in Beijing Friendship Hospital, Capital Medical University from February 2014 to December 2021 were retrospectively analyzed, there were 44 cases of posterior pectoralis prosthesis implantation, 5 cases of anterior pectoralis prosthesis implantation. The anatomical structure of the circummammary ligament was observed under endoscopy during operation, and the annular mammary ligament was used as an anatomical marker to complete subcutaneous glandectomy and prosthesis implantation for breast reconstruction, the BREAST-Q scales were used to evaluate the postoperative effect.Results:The medial sternal ligament, sub clavicular ligament, lateral confluence ligament and triangular ligament condensation could be clearly exposed in all 49 cases. Breast reconstruction module of BREAST-Q were used to evaluate the surgery effect after breast cancer surgery, the scores of postoperative breast satisfaction, chest wall status, psychosocial status and sexual health status were 81.43±12.57, 88.39±10.61, 88.04±13.70, 74.82±15.93.Conclusion:The endoscopic technique is beneficial to expose the circummammary ligament during operation, and surgical resection and reconstruction can better restore the appearance of the breast and improve postoperative satisfaction according to the principle of membrane anatomy.

目的 分析单孔腔镜乳房重建术中吲哚菁绿（indocyanine green,ICG）荧光显影对评估乳头乳晕复合体（nipple-areola complex,NAC）血运和植入物选择的价值。方法 回顾性收集2018年11月至2020年3月期间首都医科大学附属北京友谊医院收治的19例行单孔充气法腔镜乳腺癌根治术联合乳房重建治疗的患者，该组患者应用ICG荧光显影技术，评估NAC的供血模式和缺血坏死风险，从而指导植入物选择；同时选择2017年2月至2018年10月期间于该医院行单孔充气法腔镜乳腺癌根治术联合乳房重建的14例患者作为历史对照（对照组）。比较2组患者的NAC缺血坏死、乳房满意度和植入物取出情况。结果 ICG组患者中，V1模式3例，2例出现乳头NAC缺血坏死（1级1例，2级1例）；V2模式和V3模式16例，均未出现NAC缺血坏死；所有患者未出现植入物丢失。对照组5例出现NAC缺血坏死（均属于严重缺血坏死），2例出现植入物丢失。ICG组的NAC严重缺血坏死率低于对照组（P＜0.01），但2组的植入物丢失率比较差异无统计学意义（P=0.17）。ICG组的乳房满意度评分高于对照组（P＜0.01），但2组患者的胸壁状态满意度、社会心理状态满意度和性生活满意度评分比较差异均无统计学意义（P＞0.05）。结论 ICG荧光显影可应用于假体重建手术中评估NAC的供血模式，从而指导即刻乳房重建术中植入物的选择，降低严重缺血坏死风险，以便进一步改善术后乳房满意度。