本文選題：乳腺癌 + 全乳腺切除術(shù)�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討乳腺癌全腺體切除術(shù)后即刻乳房重建在乳腺癌治療中臨床意義。方法:1.共入選2008年01月~2015年12月期間在廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院接受手術(shù)治療的183例乳腺癌患者,研究組為行乳腺癌全乳腺切除術(shù)+前哨淋巴結(jié)活檢(SLNB)/腋窩淋巴結(jié)清掃術(shù)(ALND)+即刻乳房重建的96例患者,其中乳房重建包括假體49例,背闊肌肌皮瓣29例,假體聯(lián)合背闊肌皮瓣4例,腹直肌肌皮瓣14例。對照組為行乳腺癌全乳腺切除術(shù)+SLNB/ALND的87例乳腺癌患者。2.收集乳腺癌患者的相關(guān)資料,對比研究組與對照組乳腺癌患者5年復(fù)發(fā)率、遠(yuǎn)處轉(zhuǎn)移率、無瘤生存率、總生存率、術(shù)后美容效果及術(shù)區(qū)愈合情況、術(shù)后并發(fā)癥發(fā)生率。3.統(tǒng)計(jì)學(xué)處理采用SPSS 21.0軟件。計(jì)數(shù)資料采用百分?jǐn)?shù)表示,兩組之間的差異采用卡方檢驗(yàn)。5年復(fù)發(fā)轉(zhuǎn)移率、無瘤生存率和總生存率等的計(jì)算運(yùn)用Kaplan-Meier法,兩組之間5年復(fù)發(fā)轉(zhuǎn)移率、無病生存率和總生存率等的比較采用log-rank檢驗(yàn)。計(jì)量資料數(shù)據(jù)采用均數(shù)±標(biāo)準(zhǔn)差((?)±s表示,兩組間比較采用獨(dú)立樣本t檢驗(yàn)。對5年生存率進(jìn)行單因素分析,對無瘤生存時(shí)間進(jìn)行COX回歸模型(Backward Wald)多因素分析,對患者年齡、絕經(jīng)情況、腫瘤分期、免疫組化等因素進(jìn)行COX風(fēng)險(xiǎn)回歸分析。對與并發(fā)癥可能相關(guān)的因素納入Logistic回歸模型進(jìn)行多因素分析。以P0.05為差異有統(tǒng)計(jì)學(xué)意義。乳房重建組術(shù)后美學(xué)滿意度評估參照Harris評價(jià)標(biāo)準(zhǔn)。結(jié)果:研究組與對照組的中位隨訪時(shí)間分別是69個(gè)月和58個(gè)月。1、研究組5年內(nèi)有1例出現(xiàn)局部復(fù)發(fā),對照組5年內(nèi)有3例患者出現(xiàn)局部復(fù)發(fā),研究組與對照組5年局部復(fù)發(fā)率分別是1.0%及3.4%,差異無統(tǒng)計(jì)學(xué)意義(P=0.537);研究組5年內(nèi)出現(xiàn)2例區(qū)域淋巴結(jié)轉(zhuǎn)移,對照組5年內(nèi)出現(xiàn)1例區(qū)域淋巴結(jié)轉(zhuǎn)移,研究組與對照組5年區(qū)域淋巴結(jié)轉(zhuǎn)移率分別是2.1%及1.2%,差異無統(tǒng)計(jì)學(xué)意義(P=1.000);5年遠(yuǎn)處轉(zhuǎn)移率分別是5.2%及10.3%,差異無統(tǒng)計(jì)學(xué)意義(P=0.184);5年無瘤生存率分別是91.7%及85.1%,兩者比較無統(tǒng)計(jì)學(xué)差異(P=0.135);5年總生存率分別是97.9%及98.9%,差異無統(tǒng)計(jì)學(xué)意義(P=0.695)。2、研究組術(shù)后美學(xué)滿意度Harris評價(jià)優(yōu)良率為90.5%。3、研究組術(shù)后拔管時(shí)間5~113天,中位拔管時(shí)間為13天,對照組術(shù)后拔管時(shí)間5~71天,中位拔管時(shí)間為9天,兩者間比較差異有統(tǒng)計(jì)學(xué)意義(P=0.001);研究組術(shù)后切口愈合時(shí)間6~141天,中位愈合時(shí)間13.5天,對照組術(shù)后切口愈合時(shí)間6~74天,中位愈合時(shí)間10天,兩者間比較差異有統(tǒng)計(jì)學(xué)意義(P=0.005)。4、術(shù)后并發(fā)癥:研究組術(shù)后總并發(fā)癥為20.8%,12例出現(xiàn)背部血清腫,1例皮瓣感染,2例局部皮瓣壞死,2例脂肪液化,3例切口部分裂開,2例皮瓣萎縮,1例腹壁疝;對照組術(shù)后總并發(fā)癥為8.1%,其中4例皮下積液,1例乳頭乳暈壞死,1例切緣皮膚壞死,2例切口裂開并予以II期縫合。兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P=0.016)。結(jié)論:乳腺癌全腺體切除術(shù)后即刻乳房重建與單純?nèi)橄偾谐g(shù)相比局部區(qū)域復(fù)發(fā)率、遠(yuǎn)處轉(zhuǎn)移率增高,無瘤生存率、總生存率沒有下降。另外,即刻乳房重建術(shù)后美容效果較好,但術(shù)后切口愈合時(shí)間相對較長,術(shù)后并發(fā)癥發(fā)生率相對增加。
[Abstract]:Objective: To explore the clinical significance of immediate breast reconstruction after total glandular resection of breast cancer in the treatment of breast cancer. Methods: 1. a total of 183 breast cancer patients received surgical treatment at the Affiliated Cancer Hospital of Guangxi Medical University from 01 months of 2008 to December ~2015 were selected for breast cancer total mammary resection plus sentinel lymph node biopsy (SLNB). 96 patients with axillary lymph node dissection (ALND) + immediate breast reconstruction, including 49 cases of prosthesis, 29 cases of latissimus dorsi myocutaneous flap, 4 cases of prosthesis combined with latissimus dorsi flap, 14 cases of rectus abdominis myocutaneous flap, and 87 cases of breast cancer with breast cancer total mammary resection,.2. collection of breast cancer patients were collected. The 5 year recurrence rate, distant metastasis rate, tumor free survival rate, total survival rate, postoperative beauty effect and healing condition were compared between the study group and the control group. The incidence of postoperative complications was treated with SPSS 21 software.3.. The count data were expressed as percentage points, and the difference between the two groups was detected by chi square test for the recurrence rate of.5 years. The Kaplan-Meier method was used to calculate the tumor survival rate and total survival rate. The 5 year recurrence rate, the disease free survival rate and the total survival rate between the two groups were compared with the log-rank test. The data data were compared with the mean + standard deviation (?) + s, and the two groups were compared with the independent sample t test. The single factor analysis of the 5 year survival rate was performed on no tumor. Multiple factors analysis of COX regression model (Backward Wald) was carried out for the survival time. COX risk regression analysis was performed on patients' age, menopause, tumor staging, immunohistochemistry. The factors associated with the complications were included in the multifactor analysis of the Logistic regression model. The difference of P0.05 was statistically significant. The postoperative beauty of the breast reconstruction group was beautiful. The study group and the control group were followed up for 69 months and 58 months.1 respectively. The study group had 69 months and 58 months respectively, and the study group had local recurrence in 5 years, and 3 patients in the control group had local recurrence within 5 years. The local recurrence rate of the study group and the control group was 1% and 3.4%, respectively, and the difference was not statistically significant. P=0.537); in the study group, there were 2 cases of regional lymph node metastasis in 5 years and 1 cases of regional lymph node metastasis in the control group in 5 years. The regional lymph node metastasis rate in the study group and the control group was 2.1% and 1.2%, respectively (P=1.000), and the distant metastasis rate of 5 years was 5.2% and 10.3%, respectively (P=0.184), and there was no tumor in 5 years. The survival rate was 91.7% and 85.1% respectively (P=0.135); the total survival rate of 5 years was 97.9% and 98.9% respectively, the difference was not statistically significant (P=0.695).2. The excellent rate of aesthetic satisfaction Harris in the study group was 90.5%.3, the postoperatively extubation time of the study group was 113 days, the median extubation time was 13 days, and the control group after operation time 5~7 was 5~7. 1 days, the median extubation time was 9 days, there was a significant difference between the two (P=0.001). The healing time of the incision was 6~141 days, the median healing time was 13.5 days, the healing time of the incision was 6~74 days and the median healing time was 10 days in the control group, and the difference was statistically significant (P=0.005).4. The postoperative complications: postoperative complications: total postoperative complications in the study group. The complications were 20.8%, 12 cases with back serum swelling, 1 cases of skin flap infection, 2 cases of local flap necrosis, 2 cases of fat liquefaction, 3 cases of partial cleaved incision, 2 cases of atrophy of skin flap, 1 cases of abdominal wall hernia, and 4 cases of subcutaneous effusion, 1 cases of nipple areola, 1 cases of cutting edge skin necrosis, 2 cases of incision split and II suture. The difference between the two groups was statistically significant (P=0.016). Conclusion: the local recurrence rate, the distant metastasis rate, the tumor free survival rate and the total survival rate were not decreased in the immediate breast reconstruction after total glandular resection of breast cancer, and the total survival rate was not decreased. Relatively long, the incidence rate of postoperative complications increased.
【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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