本文選題：乳腺癌 + 延遲即刻重建術(shù)�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2016年博士論文

【摘要】：第一部分環(huán)乳暈切口保留乳頭的乳房切除術(shù)聯(lián)合延遲即刻重建術(shù)在早期乳腺癌治療中的臨床應(yīng)用目的：總結(jié)環(huán)乳暈切口保留乳頭的乳房切除術(shù)聯(lián)合延遲即刻重建術(shù)在早期乳腺癌治療中的技術(shù)流程,分析此術(shù)式的主要并發(fā)癥及發(fā)生原因和相應(yīng)處理方法,評(píng)價(jià)該術(shù)式的臨床應(yīng)用價(jià)值。方法：納入2010年1月至2015年6月期間在北京協(xié)和醫(yī)院實(shí)施完成環(huán)乳暈切口保留乳頭的乳房切除術(shù)聯(lián)合延遲即刻重建術(shù)的57例早期乳腺癌患者進(jìn)行研究。收集患者相關(guān)一般性資料及疾病資料,按照統(tǒng)一流程實(shí)施手術(shù),對(duì)手術(shù)操作流程進(jìn)行詳盡記錄,對(duì)術(shù)后并發(fā)癥進(jìn)行統(tǒng)計(jì),分析并發(fā)癥發(fā)生原因并予以相應(yīng)處理,觀察療效；通過(guò)門診隨訪的方式對(duì)術(shù)后患者乳房的主觀、客觀滿意度進(jìn)行調(diào)查,評(píng)價(jià)手術(shù)效果。結(jié)果：57例早期乳腺癌患者均按照流程完成手術(shù)及乳腺癌輔助治療。術(shù)后平均隨訪26個(gè)月。術(shù)后并發(fā)癥均發(fā)生于Ⅰ期環(huán)乳暈切口保留乳頭的乳房切除術(shù)聯(lián)合擴(kuò)張器植入術(shù)后。主要近期并發(fā)癥包括：乳頭乳暈區(qū)血運(yùn)障礙：乳頭乳暈區(qū)部分壞死21例(36.8%)、乳頭乳暈區(qū)完全壞死1例(1.8%),切口愈合不良3例,切口感染1例和皮下積液3例；遠(yuǎn)期并發(fā)癥主要為擴(kuò)張器植入相關(guān)并發(fā)癥,包括：擴(kuò)張器暴露1例,擴(kuò)張器擴(kuò)張失敗1例以及擴(kuò)張器移位6例。乳房重建術(shù)后主觀滿意度為優(yōu)和良的占66.7%；客觀滿意度為優(yōu)良的占71.9%,結(jié)論：對(duì)于有保乳愿望但不具備保乳條件的早期乳腺癌患者,環(huán)乳暈切口保留乳頭的乳房切除切除聯(lián)合延遲即刻重建術(shù)可以獲得良好的美學(xué)效果及主觀、客觀滿意度。乳頭乳暈區(qū)部分壞死和擴(kuò)張器植入相關(guān)并發(fā)癥是該術(shù)式的主要并發(fā)癥,可以通過(guò)改善手術(shù)操作及術(shù)后管理減少并發(fā)癥發(fā)生。通過(guò)乳腺腫瘤外科和整形外科的緊密合作,該術(shù)式可以順利有效的完成,可以將該術(shù)式作為中國(guó)女性早期乳腺癌患者手術(shù)治療的重要組成部分。第二部分乳房延遲即刻重建術(shù)后乳腺癌患者的生命質(zhì)量及其相關(guān)因素分析目的：了解環(huán)乳暈切口保留乳頭的乳房切除術(shù)聯(lián)合延遲即刻重建術(shù)后乳腺癌患者的生命質(zhì)量(Quality of Life, QOL)現(xiàn)狀并分析其影響因素,以了解此術(shù)式對(duì)患者術(shù)后QOL的影響,找到此術(shù)式的適合人群,根據(jù)相關(guān)影響因素予以針對(duì)性措施,以提高此類患者的QOL。方法：2016年1月至2016年6月于北京協(xié)和醫(yī)院隨訪的57例環(huán)乳暈切口保留乳頭的乳房切除術(shù)聯(lián)合延遲即刻重建術(shù)后患者,采用FACT-B(中文版4.0版)量表對(duì)患者QOL進(jìn)行調(diào)查,通過(guò)相關(guān)性分析尋找影響QOL的因素。結(jié)果：57例環(huán)乳暈切口保留乳頭的乳房切除術(shù)聯(lián)合延遲即刻重建術(shù)后乳腺癌患者各領(lǐng)域生命質(zhì)量狀況良好。生理狀況領(lǐng)域評(píng)分20分～28分,平均得分25.05±1.76分；社會(huì)／家庭狀況領(lǐng)域評(píng)分15～28分,平均得分25.02±3.28分；情感狀況領(lǐng)域評(píng)分11～24分,平均得分18.79±3.76分；功能狀況領(lǐng)域評(píng)分10～28分,平均得分20.96±4.56分；附加關(guān)注領(lǐng)域評(píng)分22-36分,平均得分29.54±2.82分；FACT-G量表總分評(píng)分65-108分,平均得分89.82±11.11分；FACT-B量表總分評(píng)分94-144分,平均得分119.37±11.79分。相關(guān)性分析中年齡增長(zhǎng)、絕經(jīng)與患者生命質(zhì)量呈負(fù)相關(guān)(r0,P0.05),已婚、未育有子女、未接受內(nèi)分泌治療及術(shù)后時(shí)間延長(zhǎng)與生命質(zhì)量呈正相關(guān)(r0,P0.05)。結(jié)論:延遲即刻重建術(shù)可以使患者獲得較高的的生命質(zhì)量,是乳腺癌患者理想的乳房重建術(shù)式。選擇適合的患者實(shí)施此手術(shù)并根據(jù)相關(guān)影響因素予以針對(duì)性干預(yù),可以提高此類乳腺癌患者的生命質(zhì)量。第三部分保乳術(shù)和延遲即刻重建術(shù)對(duì)乳腺癌患者生命質(zhì)量影響的對(duì)比研究目的：比較保乳術(shù)及延遲即刻重建術(shù)對(duì)乳腺癌患者術(shù)后生命質(zhì)量(QOL)的影響,為手術(shù)方式的選擇提供依據(jù)。方法：2016年3月至2016年4月于北京協(xié)和醫(yī)院乳腺外科門診隨訪乳腺癌術(shù)后的保乳及延遲即刻重建患者共64例,其中保乳手術(shù)組30例,延遲即刻重建手術(shù)組34例。應(yīng)用FACT-B量表對(duì)兩組患者進(jìn)行生命質(zhì)量測(cè)評(píng)并予以比較。結(jié)果:保乳手術(shù)組和延遲即刻重建術(shù)組乳腺癌患者均能獲得較高的QOL,FACT-B,總分分別為111.20±3.18和113.40±9.98。在生理狀況、社會(huì)/家庭狀況、情感狀況、功能狀況以及總體生命質(zhì)量評(píng)價(jià)FACT-G和FACT-B方面,乳房延遲即刻重建組和保乳組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；乳房延遲即刻重建組患者在附加關(guān)注(乳腺癌特異模塊)方面QOL得分優(yōu)于保乳術(shù)組,差異有統(tǒng)計(jì)學(xué)意義(29.37±2.72 vs 24.05±7.01,P0.05)。結(jié)論：乳腺癌保乳術(shù)和延遲即刻再造術(shù)術(shù)后患者均可獲得良好的QOL,是保留和恢復(fù)乳腺癌術(shù)后乳房外觀形態(tài)的理想手術(shù)方式。延遲即刻重建術(shù)后患者生命質(zhì)量與保乳術(shù)后患者無(wú)明顯差異。對(duì)于不具備保乳條件的乳腺癌患者,可以選擇全乳切除術(shù)后延遲即刻重建術(shù)以獲得良好的生命質(zhì)量。
[Abstract]:The first part of the clinical application of the circum areola incisional papillectomy combined with delayed immediate reconstruction in the treatment of early breast cancer: a summary of the technical flow of the circum areola incisional papillectomy combined with delayed immediate reconstruction in the treatment of early breast cancer, and to analyze the major complications and the occurrence of this operation. Methods: To evaluate the clinical application value of the operation. Methods: 57 cases of early breast cancer patients were carried out in Peking Union Medical College Hospital during the period from January 2010 to June 2015. The patients with early breast cancer and delayed immediate reconstruction were carried out in Peking Union Medical College Hospital. According to the unified process, the operation was performed, the operation process was recorded in detail, the postoperative complications were counted, the causes of the complications were analyzed, and the curative effect was observed. The subjective and objective satisfaction of the breasts after the operation was investigated and the results were evaluated. The results were 57 cases. All patients were followed up for 26 months after operation. The postoperative complications occurred in stage I mastectomy combined with dilator implantation. The main recent complications included: blood transport disorders in the nipple areola area: 21 cases of nipple areola necrosis (36. 8%) 1 cases of complete necrosis of nipple areola (1.8%), 3 cases of wound healing, 1 cases of incisional infection and 3 cases of subcutaneous effusion. The long-term complications were mainly dilator implantation related complications, including 1 cases of dilator exposure, 1 dilator dilatation and 6 dilator displacement. The subjective satisfaction after breast reconstruction was 66.7%; The objective satisfaction is 71.9%. Conclusion: for breast cancer patients with breast conserving desire but not with breast conserving conditions, the mamastectomy combined with delayed immediate reconstruction of the circum areola incision retaining nipple can obtain good aesthetic effects and subjective, objective satisfaction. Partial necrosis of the nipple areola and the expander implant phase The complication is the main complication of the operation, and the complications can be reduced by improving operation and postoperative management. Through the close cooperation of breast cancer surgery and plastic surgery, the operation can be successfully completed and can be used as an important part of the surgical treatment of early breast cancer patients in Chinese women. Second Analysis of the quality of life and related factors of breast cancer patients after partial breast delayed immediate reconstruction. Objective: to understand the status of Quality of Life (QOL) in patients with breast cancer after delayed immediate reconstruction of the annular areola incision combined with delayed immediate reconstruction of breast cancer (QOL) and analyze its influencing factors in order to understand the postoperative QOL In order to improve the QOL. method of this type of patient, 57 cases of circum areola incisional papillectomy combined with delayed immediate reconstruction were treated by FACT-B (Chinese version 4 edition) in the Peking Union Medical College Hospital from January 2016 to June 2016. The QOL was investigated and the factors affecting QOL were found by correlation analysis. Results: 57 cases of breast cancer with retained nipple with circum areola incision combined with delayed immediate reconstruction of breast cancer were in good quality of life in all fields. The score of physiological status was 20 to 28 points, the average score was 25.05 + 1.76 points, and social / family shape. The field score was scored 15~28 points, the average score was 25.02 + 3.28 points, the emotional state field score was 11~24, the average score was 18.79 + 3.76 points, the functional status field score was 10~28 points, the average score was 20.96 + 4.56 points, the additional concern area score was 22-36, the average score was 29.54 + 2.82 points, the FACT-G total score 65-108 scores, the average score 89.82 + + 1.11 points, the total score of the FACT-B scale was 94-144, the average score was 119.37 + 11.79. The age increased in the correlation analysis. The menopause was negatively correlated with the quality of life (R0, P0.05), married, and had no children. The unaccepted endocrine treatment and the extension of the postoperative time were positively correlated with the quality of life (R0, P0.05). Conclusion: delayed immediate reconstruction can make it possible. Patients with high quality of life are ideal breast reconstruction procedures for breast cancer patients. Select the appropriate patients to perform this operation and targeted intervention according to the related factors to improve the quality of life of the breast cancer patients. Third the effects of breast conserving and delayed reconstruction on the quality of life of breast cancer patients Objective: To compare the effect of breast conserving and delayed immediate reconstruction on the postoperative quality of life (QOL) of breast cancer patients, and to provide the basis for the selection of surgical methods. Methods: 64 cases of breast conserving and delayed immediate reconstruction after breast cancer surgery were followed up from March 2016 to April 2016 in the breast surgery outpatient department of Peking Union Medical College Hospital. There were 30 cases in the operation group and 34 cases of delayed immediate reconstruction. The quality of life of the two groups was evaluated and compared with the FACT-B scale. Results: the breast cancer patients and the delayed immediate reconstruction group were able to obtain higher QOL, FACT-B, the total score was 111.20 + 3.18 and 113.40 + 9.98. in the physiological condition, the social / family status, There was no significant difference in FACT-G and FACT-B between the immediate reconstruction group and the breast conserving group (P0.05), and the QOL score of the breast delayed immediate reconstruction group was better than that in the breast conserving group (29.37 + 2.72 V). S 24.05 + 7.01, P0.05). Conclusion: breast conserving and delayed immediate reconstruction can obtain good QOL. It is an ideal way to retain and restore breast appearance after breast cancer operation. The quality of life after delayed immediate reconstruction is not significantly different from that after breast conserving surgery. For breast cancer patients who do not have breast conserving conditions Patients with cancer can choose immediate delayed reconstruction after total mastectomy to achieve good quality of life.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R737.9

【參考文獻(xiàn)】

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1 陳穎;陳嘉健;陳嘉瑩;楊r嚵，

本文編號(hào)：1928296