早期乳腺癌超象限切除同期背闊肌皮瓣轉移乳房重建術的臨床研究
發(fā)布時間：2018-10-26 16:01
【摘要】：目的 本研究通過分析早期乳腺癌患者行乳腺癌超象限切除同期背闊肌皮瓣轉移乳房重建術與傳統(tǒng)保乳治療方式的近、遠期療效,評估乳腺癌超象限切除同期背闊肌皮瓣轉移乳房重建術,術后不行放療的可行性及美容效果。方法 分析河北大學附屬醫(yī)院腫瘤外科2009年5月至2013年12月行超象限切除同期背闊肌皮瓣轉移乳房重建術后未行放療患者22例(A組)及傳統(tǒng)保乳術患者44例(B組)。對在臨床上被認為對預后有重要影響變量包括乳腺癌TNM分期、腋窩淋巴結狀態(tài)、雌激素受體狀態(tài)、Her-2狀態(tài)4個變量進行1:2配對。入組病例均有完整的臨床及隨訪資料。所有數(shù)據(jù)采用SPSS17.0軟件進行分析,對計數(shù)資料間的比較采用χ2檢驗,應用Kaplan-Meier法計算生存率,繪制生存曲線,采用log-rank檢驗比較生存曲線間差異。檢驗水準α=0.05,P0.05時差異有統(tǒng)計學意義。比較兩組患者術后并發(fā)癥、局部復發(fā)率、無病生存率、總生存率及術后乳房美容效果。結果 對術后乳房美容效果的主觀滿意度調(diào)查結果顯示,A組患者術后對乳房美觀的總滿意率為81.8%(18/22)。B組患者術后對乳房美觀的總滿意率為86.4%(38/44)。兩組之間對比差異無統(tǒng)計學意義(P0.05)。兩組手術方式并發(fā)癥均較少,皮瓣壞死、切口感染、上肢水腫及功能障礙發(fā)生率差異均無統(tǒng)計學意義(P0.05)。A組的皮下積液發(fā)生率高于B組(P0.05)。A組的隨訪時限:9-62個月,中位隨訪時間為42個月,有1例局部復發(fā),2例出現(xiàn)遠處轉移,均為肺轉移,其中1例因轉移死亡;B組的隨訪時限為:6-62個月,中位隨訪時間為38.5個月。有4例出現(xiàn)局部復發(fā)、3例出現(xiàn)了遠處轉移,1例為肺轉移,2例為肝轉移,其中2例因轉移死亡。兩組患者術后局部復發(fā)率、無病生存率、總生存率對比差異均無統(tǒng)計學意義(P0.05)。結論 我們對早期乳腺癌行乳腺腫物超象限切除,同時行腋下淋巴結清掃,因考慮殘腔閉合后影響乳腺外形,術中采用整形方法,應用背闊肌皮瓣成形術對乳腺進行整形。術后患者雖未行放療,但生存率及復發(fā)率和傳統(tǒng)保乳術相比差異無統(tǒng)計學意義,同時使患者獲得良好的美容效果。
[Abstract]:Objective to analyze the near and long term effects of breast reconstruction and traditional breast conserving treatment in patients with early breast cancer undergoing breast cancer superquadrant resection and latissimus dorsi flap transfer. To evaluate the feasibility and cosmetic effect of breast reconstruction with supraquadrant resection and latissimus dorsi flap transfer. Methods from May 2009 to December 2013, 22 patients (group A) without radiotherapy and 44 patients with traditional breast conserving surgery (group B) underwent supersonic quadrant resection and reconstruction of breast with latissimus dorsi flap transfer. Four variables, including breast cancer TNM stage, axillary lymph node status, estrogen receptor status, and Her-2 status, were matched at 1:2. All patients had complete clinical and follow-up data. All the data were analyzed by SPSS17.0 software, 蠂 2 test was used to compare the counting data, the survival rate was calculated by Kaplan-Meier method, and the survival curve was plotted. The difference of survival curve was compared by log-rank test. The difference was statistically significant when the test level was 偽 = 0.05 (P 0.05). The postoperative complications, local recurrence rate, disease-free survival rate, overall survival rate and postoperative breast cosmetic effect were compared between the two groups. Results the results of subjective satisfaction survey on the effect of breast beauty after operation showed that, The total satisfaction rate of breast beauty in group A was 81.8% (86.4%, 38 / 44) in group A (18 / 22). B). There was no significant difference between the two groups (P0.05). The complications of the two groups were less, skin flap necrosis, incision infection, There was no significant difference in the incidence of upper limb edema and dysfunction (P 0.05) the incidence of subcutaneous effusion in). A group was higher than that in B group (P0.05). A group: 9-62 months, median follow-up time was 42 months). Local recurrence occurred in 1 case and distant metastasis in 2 cases, in which 1 case died of metastasis. The follow-up time of group B was 6-62 months and the median follow-up time was 38. 5 months. There were 4 cases of local recurrence, 3 cases of distant metastasis, 1 case of lung metastasis and 2 cases of liver metastasis, of which 2 cases died of metastasis. There was no significant difference in local recurrence rate, disease-free survival rate and overall survival rate between the two groups (P0.05). Conclusion in the early stage of breast cancer, we performed superquadrant mastectomy and axillary lymph node dissection. Due to the influence of residual cavity closure on breast shape, we used plastic surgery and latissimus dorsi myocutaneous flap for breast reconstruction. Although the patients were not treated with radiotherapy, the survival rate and recurrence rate were not significantly different from those of traditional breast conserving surgery.
【學位授予單位】：河北大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R737.9
本文編號：2296257
[Abstract]:Objective to analyze the near and long term effects of breast reconstruction and traditional breast conserving treatment in patients with early breast cancer undergoing breast cancer superquadrant resection and latissimus dorsi flap transfer. To evaluate the feasibility and cosmetic effect of breast reconstruction with supraquadrant resection and latissimus dorsi flap transfer. Methods from May 2009 to December 2013, 22 patients (group A) without radiotherapy and 44 patients with traditional breast conserving surgery (group B) underwent supersonic quadrant resection and reconstruction of breast with latissimus dorsi flap transfer. Four variables, including breast cancer TNM stage, axillary lymph node status, estrogen receptor status, and Her-2 status, were matched at 1:2. All patients had complete clinical and follow-up data. All the data were analyzed by SPSS17.0 software, 蠂 2 test was used to compare the counting data, the survival rate was calculated by Kaplan-Meier method, and the survival curve was plotted. The difference of survival curve was compared by log-rank test. The difference was statistically significant when the test level was 偽 = 0.05 (P 0.05). The postoperative complications, local recurrence rate, disease-free survival rate, overall survival rate and postoperative breast cosmetic effect were compared between the two groups. Results the results of subjective satisfaction survey on the effect of breast beauty after operation showed that, The total satisfaction rate of breast beauty in group A was 81.8% (86.4%, 38 / 44) in group A (18 / 22). B). There was no significant difference between the two groups (P0.05). The complications of the two groups were less, skin flap necrosis, incision infection, There was no significant difference in the incidence of upper limb edema and dysfunction (P 0.05) the incidence of subcutaneous effusion in). A group was higher than that in B group (P0.05). A group: 9-62 months, median follow-up time was 42 months). Local recurrence occurred in 1 case and distant metastasis in 2 cases, in which 1 case died of metastasis. The follow-up time of group B was 6-62 months and the median follow-up time was 38. 5 months. There were 4 cases of local recurrence, 3 cases of distant metastasis, 1 case of lung metastasis and 2 cases of liver metastasis, of which 2 cases died of metastasis. There was no significant difference in local recurrence rate, disease-free survival rate and overall survival rate between the two groups (P0.05). Conclusion in the early stage of breast cancer, we performed superquadrant mastectomy and axillary lymph node dissection. Due to the influence of residual cavity closure on breast shape, we used plastic surgery and latissimus dorsi myocutaneous flap for breast reconstruction. Although the patients were not treated with radiotherapy, the survival rate and recurrence rate were not significantly different from those of traditional breast conserving surgery.
【學位授予單位】：河北大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R737.9
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