本文選題：乳腺癌 + 保留乳頭乳暈皮下乳房切除��； 參考：《蚌埠醫(yī)學院》2017年碩士論文

【摘要】：目的:探討即刻假體重建(Immediate Prosthesis Reconstruction,IPR)、即刻背闊肌重建(Immediate Latissimus Dorsi Myocutaneous Flap Reconstruction,ILDMFR)在保留乳頭乳暈乳房切除術(Nipple-Sparing Mastectomy,NSM)中對乳腺癌治療的應用價值及美容效果。方法:對蚌埠醫(yī)學院第一附屬醫(yī)院腫瘤外科2012年1月至2016年1月期間,32例保留乳頭乳暈乳房切除術加即刻假體重建或即刻背闊肌重建的早期乳腺癌患者臨床資料進行回顧性分析,并通過電話和門診的隨訪方式,評估兩種術式的應用價值及美容效果。結果:搜集2012年1月至2016年1月,32例NSM plus IPR或NSM plus ILDMFR的早期乳腺癌患者臨床資料,其中背闊肌組18例,假體組14例。背闊肌組年齡為(22~64)歲,平均年齡(41.00±9.65)歲,中位年齡42歲;假體組年齡為(28~56)歲,平均年齡(40.79±8.52)歲,中位年齡41歲。背闊肌組手術時間(180~326)分鐘,平均(223.89±40.28)分鐘,術后住院時間(6~14)天,平均住院(8.61±2.33)天,住院費用(13589~18924)元,平均花費(15938.89±1723.67)元。假體組手術時間(170~340)分鐘,平均(202.64±48.10)分鐘,術后住院時間(6~12)天,平均住院(7.79±1.58)天,住院費用(18254~24032)元,平均花費(20223.86±1741.01)元。術后并發(fā)癥:背闊肌組1例出現(xiàn)局部皮瓣缺血壞死,2例發(fā)生皮下血清腫,1例再造乳房萎縮。假體組出現(xiàn)包膜攣縮1例,乳頭缺血1例,局部感染1例。術后美學評價:背闊肌組優(yōu)良率為88.89%(16/18),假體組優(yōu)良率85.71%(12/14)。患者均生存,背闊肌組1例發(fā)生骨轉移,均無局部復發(fā),無其他術后并發(fā)癥。兩者在術后并發(fā)癥發(fā)生率和美容效果上無明顯差異(P0.05);NSM plus IPR在手術時間和住院天數(shù)上用時較少,兩者存在差異(P0.05);NSM plus ILDMFR費用低廉,具有經(jīng)濟優(yōu)勢,兩者存在顯著差異(P0.05)。結論:對于選擇合適的病人NSM plus IPR或NSM plus ILDMFR是安全可靠的,二者在安全性及美容效果上無顯著差別。IPR的優(yōu)勢是方法簡單,具有手術創(chuàng)傷小、術后恢復快等諸多優(yōu)點。NSM plus ILDMFR的成本較低,技術簡單,更符合我國國情。對于合適的患者兩者都值得進一步推廣。
[Abstract]:Objective: to investigate the value of immediate Prosthesis reconstruction (IPR) and immediate latissimus Dorsi Myocutaneous flap reconstruction (ILDMFR) in the treatment of breast cancer during Nipple-Sparing mastectomy (NSM). Methods: from January 2012 to January 2016, 32 cases of early breast cancer with nipple-preserving areola mastectomy plus immediate prosthesis reconstruction or immediate latissimus dorsi reconstruction were retrospectively analyzed in the oncology surgery of the first affiliated Hospital of Bengbu Medical College. For retrospective analysis, The application value and cosmetic effect of the two operations were evaluated by telephone and outpatient follow-up. Results: from January 2012 to January 2016, the clinical data of 32 patients with early breast cancer of NSM plus IPR or NSM plus ILDMFR were collected, including 18 cases in latissimus dorsi group and 14 cases in prosthesis group. In latissimus dorsi group, the average age was (41.00 鹵9.65) years, the median age was 42 years old, and in the prosthesis group, the age was (280.79 鹵8.52) years, with a median age of 41 years. In the latissimus dorsi group, the operation time was (180 鹵40.28) minutes, the average time was (223.89 鹵40.28) minutes, the postoperative hospitalization time was (6 ~ 14) days, the average hospital stay was (8.61 鹵2.33) days, the hospitalization cost was (13589 ~ 18924) yuan, the average cost was (15938.89 鹵1723.67) yuan. In the prosthesis group, the operation time was (170 ~ 340) minutes, the average time was (202.64 鹵48.10) minutes, the postoperative hospitalization time was (6 ~ 12) days, the average hospital stay was (7.79 鹵1.58) days, the hospitalization cost was (1 8254 ~ 24032) yuan, the average cost was (20223.86 鹵1741.01) yuan. Postoperative complications: 1 case of latissimus dorsi group showed ischemic necrosis of local flaps 2 cases of subcutaneous serum swelling 1 case of reconstruction of breast atrophy. In the prosthesis group, capsule contracture occurred in 1 case, nipple ischemia in 1 case and local infection in 1 case. Postoperative aesthetic evaluation: the excellent and good rate of latissimus dorsi group was 88.89% (16 / 18), and that of prosthesis group was 85.71% (12 / 14). In latissimus dorsi group, bone metastasis occurred in 1 case, no local recurrence and no other postoperative complications. There was no significant difference in the incidence of postoperative complications and cosmetic effect between the two groups (P0.05). There was a significant difference between the two groups in the operation time and the length of stay (P0.05). (P0.05) the cost of NSM plus ILDMFR was lower than that of the latter (P0.05), and there was a significant difference between the two groups (P0.05). Conclusion: it is safe and reliable to select suitable patients with NSM plus IPR or NSM plus ILDMFR. There is no significant difference in safety and beauty effect between them. The cost of NSM plus ILDMFR is lower, the technology is simple, and it is more suitable for our country. Both are worthy of further promotion for appropriate patients.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9

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相關期刊論文 前2條

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本文編號：2058716