本文選題：保守性乳房切除術(shù)　切入點：假體　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的分析保守性乳房切除術(shù)與即刻乳房重建術(shù)在治療早期乳腺癌方面的可行性和安全性、重建乳房的美容效果。方法回顧分析2012年12月至2017年2月間在廣西醫(yī)科大學(xué)第一附屬醫(yī)院行保守性乳房切除術(shù)(CM)和即刻乳房重建術(shù)治療早期乳腺癌患者的術(shù)后并發(fā)癥率、術(shù)后局部復(fù)發(fā)和遠(yuǎn)處轉(zhuǎn)移率,術(shù)后3年的生存率,與同期乳腺癌改良根治術(shù)(MRM)患者做配對分析比較。比較保留乳頭乳暈的乳房切除術(shù)(NSM)和保留皮膚的乳房切除術(shù)(SSM)兩組患者對重建乳房的滿意度。結(jié)果總計完成CM術(shù)55例,SSM術(shù)17例,其中行假體乳房重建5例,帶蒂背闊肌皮瓣移植自體重建12例。38例患者接受了40例NSM術(shù),23例患者行假體乳房重建術(shù),其中2例作了對側(cè)乳房預(yù)防性切除和重建,15例行帶蒂背闊肌肌皮瓣重建乳房。CM手術(shù)與MRM術(shù)的術(shù)后并發(fā)癥率比較無統(tǒng)計學(xué)差異(10.9%vs 12.7%),經(jīng)卡方檢驗,P=0.768。兩組術(shù)后3年生存率均為100%,術(shù)后3年內(nèi)復(fù)發(fā)、轉(zhuǎn)移率、生存率差異無統(tǒng)計學(xué)意義,均經(jīng)卡方檢驗P0.05。CM術(shù)后患者對重建乳房美容效果滿意為48例,不滿意7例,總體滿意率為87.3%。NSM手術(shù)組患者滿意率為94.7%(滿意36例,不滿意2例)。SSM手術(shù)組患者對重建乳房滿意率達(dá)70.6%(滿意12例,不滿意5例)兩組患者術(shù)后滿意率相比較差異有顯著性差異,具有統(tǒng)計學(xué)意義,經(jīng)卡方檢驗P=0.024。結(jié)論1、對于早期乳腺癌,尤其是低復(fù)發(fā)風(fēng)險和預(yù)后好的患者可以選擇CM手術(shù),預(yù)后是安全的;2、CM術(shù)和MRM術(shù)組相比較,CM術(shù)并不增加乳腺癌患者術(shù)后并發(fā)癥率、局部復(fù)發(fā)率、遠(yuǎn)處轉(zhuǎn)移率,CM術(shù)后能保留乳房外形,患者滿意度高,特別適合中小及輕中度下垂乳房的女性患者;3、NSM手術(shù)組和SSM手術(shù)組相比較,NSM組患者對重建乳房的滿意度更高,美容效果更好;4、CM手術(shù)后即刻LDMF乳房重建成功率高,術(shù)后并發(fā)癥率低。但背闊肌組織量有限,不適合大、中重度下垂乳房患者的重建。
[Abstract]:Objective to analyze the feasibility and safety of conservative mastectomy and immediate breast reconstruction in the treatment of early breast cancer.Methods from December 2012 to February 2017, the rate of postoperative complications, local recurrence and distant metastasis of patients with early breast cancer treated by conservative mastectomy and immediate breast reconstruction in the first affiliated Hospital of Guangxi Medical University were analyzed retrospectively.The 3-year survival rate was compared with that of the patients with modified radical mastectomy (MRM).The satisfaction with breast reconstruction was compared between nipple-constricted mastectomy (NSM) and skin-preserving mastectomy (SSM).Results A total of 17 cases were performed CM operation, including 5 cases of prosthetic breast reconstruction, 12 cases of autologous reconstruction of pedicled latissimus dorsi myocutaneous flap and 23 cases of prosthetic breast reconstruction in 40 cases of NSM.Two of them underwent contralateral mastectomy and reconstruction with pedicled latissimus dorsi myocutaneous flap in 15 cases. There was no significant difference in postoperative complication rate between the operation of pedicled latissimus dorsi myocutaneous flap and MRM.The 3-year survival rate was 100% in both groups. There was no significant difference in recurrence, metastasis rate and survival rate within 3 years after operation. After chi-square test, 48 cases were satisfied with breast reconstruction and 7 cases were not satisfied with the cosmetic effect of breast reconstruction.The overall satisfaction rate was 94.7in 87.3%.NSM group (36 cases satisfactory, 2 cases unsatisfactory, 70.6%) (12 cases satisfactory and 5 cases unsatisfactory). There was a significant difference between the two groups.It has statistical significance, P0. 024 by chi-square test.Conclusion 1. For early breast cancer, especially for patients with low risk of recurrence and good prognosis, CM operation is safe. Compared with MRM group, CM operation does not increase the rate of postoperative complications and local recurrence of breast cancer.The distant metastasis rate (CM) could preserve the shape of the breast after operation, and the patients' satisfaction was high. It was especially suitable for the female patients with moderate or moderate prolapse of breast. The patients in the SSM group were more satisfied with the breast reconstruction than those in the control group.The cosmetic effect was better. The success rate of immediate LDMF breast reconstruction was high and the postoperative complication rate was low.But latissimus dorsi tissue is limited, not suitable for large, moderate and severe prolapse breast reconstruction.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9

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相關(guān)期刊論文 前2條

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本文編號：1696950