【摘要】：目的隨著女性對(duì)美觀的追求,越來(lái)越多的患者在乳腺癌改良根治術(shù)后選擇乳房重建。本研究的目的是探討即刻乳房重建術(shù)安全性及其相關(guān)的并發(fā)癥。方法本研究對(duì)天津醫(yī)科大學(xué)腫瘤醫(yī)院2011年1月份至2012年12月份收治的223例經(jīng)病理診斷為乳腺癌的患者進(jìn)行回顧性分析。計(jì)數(shù)資料的比較采用χ2檢驗(yàn)或確切概率法,計(jì)量資料的比較采用t檢驗(yàn)或Mann-Whitney檢驗(yàn),定義P值小于0.05認(rèn)為具有統(tǒng)計(jì)學(xué)意義。結(jié)果將患者分為即刻重建術(shù)組(n=108例)和改良根治術(shù)組(n=115例)。即刻重建術(shù)組和改良根治術(shù)組的中位術(shù)后輔助化療開(kāi)始時(shí)間分別為21天和11天,差異有統(tǒng)計(jì)學(xué)意義(P0.001),但并沒(méi)有患者超過(guò)12周。在并發(fā)癥發(fā)生率方面,即刻重建術(shù)組血腫的發(fā)生率比改良根治術(shù)組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。但即刻重建術(shù)組患者中二次手術(shù)以及脂肪壞死的發(fā)生率均比改良根治術(shù)組高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),而即刻重建術(shù)組感染的發(fā)生率比改良根治術(shù)組高,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。在108例接受即刻乳房重建的患者中,有22例患者接受了術(shù)后放療,行術(shù)后放療的患者二次手術(shù)的發(fā)生率比未行放療的患者高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。且行術(shù)后放療的患者對(duì)術(shù)后美容效果的滿意率低于未行術(shù)后放療的患者,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。在108例患者中,有65例患者應(yīng)用自體組織重建,其中有12例患者接受了術(shù)后放療。在應(yīng)用自體組織重建的患者中,行術(shù)后放療的患者,其二次手術(shù)和皮瓣壞死的發(fā)生率均比未行放療的高,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。但術(shù)后放療的患者脂肪壞死發(fā)生較未行放療組高,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。而兩組患者在美容效果方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。在108例患者中,有43例患者應(yīng)用假體重建,其中有10例患者接受了術(shù)后放療。行術(shù)后放療的患者,其擴(kuò)張器/假體外露、包膜攣縮及二次手術(shù)的發(fā)生率均比未行放療者高,且差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。同時(shí),行術(shù)后放療的患者美容效果滿意度比未行放療者低,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論相對(duì)于改良根治術(shù)而言,即刻乳房重建會(huì)使患者術(shù)后輔助化療開(kāi)始時(shí)間延長(zhǎng),但沒(méi)有患者超過(guò)12周,不會(huì)影響患者的預(yù)后,因此沒(méi)有顯著的臨床意義。即刻重建術(shù)組患者二次手術(shù)和脂肪壞死的發(fā)生率均明顯高于改良根治術(shù)組。總的來(lái)說(shuō),術(shù)后放療會(huì)使即刻乳房重建患者二次手術(shù)發(fā)生率顯著增加,同時(shí)使其美容效果滿意度顯著降低。但對(duì)于自體組織重建而言,放療僅會(huì)使其脂肪壞死的發(fā)生率顯著增加。而對(duì)于假體重建,放療會(huì)使其擴(kuò)張器/假體外露、包膜攣縮、二次手術(shù)等并發(fā)癥發(fā)生率明顯增加,而美容效果滿意度顯著降低。
[Abstract]:Objective with the pursuit of beauty in women, more and more patients choose breast reconstruction after modified radical mastectomy. The purpose of this study was to investigate the safety of immediate breast reconstruction and its related complications. Methods 223 patients with breast cancer diagnosed pathologically from January 2011 to December 2012 in Cancer Hospital of Tianjin Medical University were analyzed retrospectively. The comparison of counting data was carried out by 蠂 2 test or exact probability method, and t test or Mann-Whitney test was used to compare the measured data. It was considered statistically significant that the P value was less than 0.05. Results the patients were divided into immediate reconstruction group (n = 108) and modified radical operation group (n = 115). The median postoperative adjuvant chemotherapy time in immediate reconstruction group and modified radical operation group was 21 days and 11 days, respectively, the difference was statistically significant (P0.001), but no patients were more than 12 weeks. In terms of the incidence of complications, the incidence of hematomas in the immediate reconstruction group was lower than that in the modified radical operation group, the difference was statistically significant (P 0.05). However, the incidence of secondary operation and fat necrosis in immediate reconstruction group was higher than that in modified radical operation group, the difference was statistically significant (P 0.05), but the incidence of infection in immediate reconstruction group was higher than that in modified radical operation group, but the difference was not statistically significant (P 0.05). Of the 108 patients who received immediate breast reconstruction, 22 patients received postoperative radiotherapy. The incidence of secondary surgery in patients undergoing postoperative radiotherapy was significantly higher than that in patients without radiotherapy (P 0.05). The satisfaction rate of postoperative radiotherapy patients was lower than that of patients without postoperative radiotherapy, the difference was statistically significant (P 0.05). Of the 108 patients, 65 were treated with autologous tissue reconstruction, and 12 of them received postoperative radiotherapy. In the patients with autologous tissue reconstruction, the incidence of secondary surgery and flap necrosis in patients undergoing postoperative radiotherapy was higher than that without radiotherapy, but the difference was not statistically significant (P 0.05). However, the incidence of fat necrosis in patients treated with postoperative radiotherapy was higher than that in patients without radiotherapy, and the difference was statistically significant (P 0.05). However, there was no significant difference in cosmetic effect between the two groups (P 0.05). Of the 108 patients, 43 were treated with artificial reconstruction, and 10 of them received postoperative radiotherapy. The incidence of dilator / prosthesis exposure, capsule contracture and secondary operation in patients undergoing postoperative radiotherapy was higher than that in patients without radiotherapy, and the difference was statistically significant (P 0.05). At the same time, the cosmetic effect satisfaction of patients treated with postoperative radiotherapy was lower than that of patients without radiotherapy, and the difference was statistically significant (P 0.05). Conclusion compared with modified radical mastectomy, immediate breast reconstruction can prolong the start time of postoperative adjuvant chemotherapy, but no patient has more than 12 weeks, which will not affect the prognosis of patients, so it has no significant clinical significance. The incidence of secondary operation and fat necrosis in immediate reconstruction group was significantly higher than that in modified radical operation group. In general, postoperative radiotherapy can significantly increase the incidence of secondary surgery in patients with immediate breast reconstruction, and significantly reduce the satisfaction of cosmetic effect. However, for autologous tissue reconstruction, radiotherapy only significantly increased the incidence of fat necrosis. For the reconstruction of the prosthesis, radiotherapy can significantly increase the incidence of complications such as dilator / prosthesis exposure, capsule contracture, secondary operation and so on, while the satisfaction of cosmetic effect is significantly decreased.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R737.9

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