本文選題：乳腺癌　切入點：乳房重建　出處：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過系統(tǒng)的回顧國內外已發(fā)表的所有文獻,綜合性的探討乳腺癌患者,乳房切除術后乳房重建的安全性和必要性,比較單純乳腺癌乳房切除術患者和乳腺癌切除術后立即重建患者的5年無病生存率(DFS)、總生存率(OS)是否存在統(tǒng)計學差異,了解乳腺癌患者乳房切除術后,立即進行乳房再造重建對病人的預后有無影響。方法:以“乳腺癌”“重建”為中文檢索詞,以“Breast Neoplasms‖、 breest cancer‖、 Mammaplasty‖ breast reconstruction‖為英文檢索詞,通過檢索PubMed、Embase、Cochrane及萬方數(shù)據(jù)庫中2006至今國內外公開發(fā)表的關于乳腺癌乳房切除術后乳房重建方面相關的文獻,采用Cochrane協(xié)作網(wǎng)提供的RevMan 5.2系統(tǒng)軟件,對符合納入標準要求的研究進行薈萃分析和系統(tǒng)評價。結果:最終納入7篇英文文獻,1篇中文文獻,8篇文獻均為回顧性研究,其中6篇獨立的研究小組的隊列研究,總人數(shù)為2858例,術后立即重建組為1265例,單純乳房切除術組為1593例。從納入文獻來看,乳腺癌切除術后重建的患者相對年齡小于單純乳房切除手術的患者,乳腺癌分期可為初期、中期和晚期患者,隨訪時間均大于1年,而大部分的患者都經(jīng)過了輔助治療,乳腺癌的重建方式大體可分為自體和異體兩種,自體大多選用局部肌皮瓣進行移植,常用的手術方式如腹直肌肌皮瓣、背闊肌肌皮瓣、臀大肌肌皮瓣,而異體重建可分為組織擴張器和假體兩種形式。兩組5年無病生存率比較,合并統(tǒng)計量OR=1.32,其95%置信區(qū)間(95%CI:0.96,1.82),該OR值無統(tǒng)計學意義,即重建組與單純乳房切除術組相比5年無病生存率無統(tǒng)計學差異(P=0.09),兩組5年總生存率比較,其合并統(tǒng)計量OR=1.36其95%可信區(qū)間(95%CI:0.86,2.14),該OR值無統(tǒng)計學意義,即,重建組與單純乳房切除術組5年OS無統(tǒng)計學差異(P=0.19)。結論:這項系統(tǒng)評價表明乳腺癌術后乳房立即重建與單純的乳腺癌切除手術相比其5年無病生存率和總生存率均無統(tǒng)計學差異,乳腺癌切除術后立即乳房重建不降低患者五年生存率,是一項安全可行的治療措施。
[Abstract]:Objective: to investigate the safety and necessity of breast reconstruction in patients with breast cancer after mastectomy by systematically reviewing all the literatures published at home and abroad.The 5-year disease-free survival rate and overall survival rate of breast cancer patients undergoing mastectomy and immediate reconstruction after mastectomy were compared statistically.Immediate breast reconstruction has an impact on the prognosis of patients.Methods: using "breast cancer" and "reconstruction" as Chinese key words, "Breast Neoplasms", "breest cancer", "Mammaplasty" and "breast reconstruction" as English key words.By searching the published literatures on breast reconstruction after mastectomy in the database of PubMedus Embase Cochrane and Wanfang from 2006 to now, the RevMan 5.2 system software provided by Cochrane Cooperative Network was used.Meta-analysis and systematic evaluation of studies that meet the requirements of inclusion criteria.Results: all of the 7 English articles and 1 Chinese literature were included in the retrospective study. Among them, 6 independent study group cohort studies were conducted in 2858 patients and 1265 patients in the immediate postoperative reconstruction group.There were 1593 cases in simple mastectomy group.According to the literature, the patients with reconstruction after breast cancer resection were less than those with simple mastectomy. The stage of breast cancer was early, middle and late, and the follow-up time was more than one year.Most of the patients were treated with adjuvant therapy. The reconstruction of breast cancer can be divided into two types: autologous and allogeneic. The local myocutaneous flap is mostly used for autotransplantation. The commonly used surgical methods are rectus abdominis myocutaneous flap, latissimus dorsi myocutaneous flap.Gluteus maximus myocutaneous flap can be divided into two types: tissue dilator and prosthesis.The 5-year disease-free survival rate of the two groups was significantly higher than that of the simple mastectomy group (P < 0.09), and the 95% confidence interval of 95% confidence interval was 95% CI: 0.96 and 1.82%. There was no significant difference in the 5-year disease-free survival rate between the reconstruction group and the simple mastectomy group, and the 5-year overall survival rate between the two groups was higher than that in the simple mastectomy group.The combined statistic (OR=1.36) and 95% CI (95% CI) showed that there was no significant difference in the OR between the reconstruction group and the simple mastectomy group (P < 0. 19).Conclusion: this systematic evaluation showed that there was no significant difference in 5-year disease-free survival rate and overall survival rate between immediate breast reconstruction and simple breast cancer resection.Immediate breast reconstruction after resection of breast cancer does not reduce the 5-year survival rate, which is a safe and feasible treatment.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.9

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本文編號：1712586