探讨腋窝单孔腔镜皮下腺体切除联合一期假体重建在乳腺癌患者中的临床疗效、肿瘤安全性及美容学结果，为优化手术方式选择提供依据。

本研究为回顾性对照研究，纳入2023年1月至2025年5月在联勤保障部队第九六〇医院行皮下腺体切除联合一期假体重建手术的129例乳腺癌女性患者。根据手术方式分为腔镜组(67例)和开放组(62例)。对两组患者的基线资料、术中与术后相关参数、并发症、肿瘤学安全性及美容满意度等进行系统比较。

两组在年龄、身体质量指数、吸烟史、糖尿病、肿瘤T/N分期、ER/PR/HER2状态及围手术期治疗等基线资料差异均无统计学意义(均P>0.05)。围手术期指标方面，腔镜组术中出血量显著少于开放组(40.9±27.6 ml vs. 71.5±66.3 ml，P＝0.001)。术后并发症方面，开放组与腔镜组总并发症发生率分别为11.3%与7.5%，差异无统计学意义(P＝0.550)。NAC缺血坏死发生率分别为3.2%与4.5%，差异亦无统计学意义(P>0.05)。美容学评价显示，术后1个月及3个月腔镜组BREAST-Q评分均高于开放组(67.96±5.33 vs. 64.11±6.38，P＝0.019；76.19±4.47 vs. 67.46±6.41，P<0.001)。腔镜组Harris评分"优"比例高于开放组(79.1% vs. 61.3%，P＝0.034)。在随访期间腔镜组出现乳头区Paget病复发1例，开放组未见局部复发；两组均未发生远处转移或死亡，组间差异均无统计学意义。

腔镜NSM联合即刻假体重建在保证手术疗效和短期肿瘤学安全性不劣于开放手术的同时，可降低术中创伤并显著提升早期美学与患者满意度，总体可为乳腺癌患者提供更优的手术选择，但仍需更长期随访以验证远期疗效与安全性。

To evaluate the clinical efficacy, oncologic safety, and aesthetic outcomes of axillary single-port endoscopic subcutaneous glandular resection combined with immediate implant reconstruction in patients with breast cancer, and to provide evidence for optimizing surgical approach selection.

This retrospective comparative study included 129 female breast cancer patients who underwent subcutaneous glandular resection with immediate implant-based reconstruction at the 960th Hospital of the Joint Logistics Support Force from Jan. 2023 to May 2025. Patients were allocated to an endoscopic group (n=67) or an open surgery group (n=62) according to surgical approach. Baseline characteristics, perioperative parameters, postoperative complications, oncologic outcomes, and aesthetic satisfaction were systematically compared between groups.

No significant differences were found between the two groups in baseline characteristics, including age, body mass index, smoking history, diabetes, tumor T/N stage, ER/PR/HER2 status, and perioperative treatments (all P>0.05). Intraoperative blood loss was significantly lower in the endoscopic group than in the open group (40.9±27.6 ml vs. 71.5±66.3 ml, P=0.001). The overall postoperative complication rates were 11.3% and 7.5% in the open and endoscopic groups, respectively, with no significant difference (P=0.550). The incidence of nipple-areolar complex (NAC) ischemia/necrosis was 3.2% versus 4.5%, also without a significant difference (P>0.05). Aesthetic evaluation showed higher BREAST-Q scores in the endoscopic group at 1 month and 3 months postoperatively (67.96±5.33 vs. 64.11±6.38, P=0.019; 76.19±4.47 vs. 67.46±6.41, P<0.001). The proportion of "excellent" Harris ratings was also higher in the endoscopic group (79.1% vs. 61.3%, P=0.034). During follow-up, one case of nipple Paget′s disease recurrence occurred in the endoscopic group, whereas no local recurrence was observed in the open group; no distant metastasis or death occurred in either group, and the between-group differences were not statistically significant.

Endoscopic nipple-sparing mastectomy with immediate implant reconstruction achieves comparable short-term oncologic safety and surgical efficacy to open surgery while reducing intraoperative trauma and significantly improving early aesthetic outcomes and patient satisfaction. Longer follow-up is warranted to confirm long-term efficacy and safety.