早期乳腺癌保守性乳房切除术治疗分析

发布时间：2018-04-01 19:20

本文选题：保守性乳房切除术　切入点：假体　出处：《广西医科大学》2017年硕士论文

【摘要】：目的分析保守性乳房切除术与即刻乳房重建术在治疗早期乳腺癌方面的可行性和安全性、重建乳房的美容效果。方法回顾分析2012年12月至2017年2月间在广西医科大学第一附属医院行保守性乳房切除术(CM)和即刻乳房重建术治疗早期乳腺癌患者的术后并发症率、术后局部复发和远处转移率,术后3年的生存率,与同期乳腺癌改良根治术(MRM)患者做配对分析比较。比较保留乳头乳晕的乳房切除术(NSM)和保留皮肤的乳房切除术(SSM)两组患者对重建乳房的满意度。结果总计完成CM术55例,SSM术17例,其中行假体乳房重建5例,带蒂背阔肌皮瓣移植自体重建12例。38例患者接受了40例NSM术,23例患者行假体乳房重建术,其中2例作了对侧乳房预防性切除和重建,15例行带蒂背阔肌肌皮瓣重建乳房。CM手术与MRM术的术后并发症率比较无统计学差异(10.9%vs 12.7%),经卡方检验,P=0.768。两组术后3年生存率均为100%,术后3年内复发、转移率、生存率差异无统计学意义,均经卡方检验P0.05。CM术后患者对重建乳房美容效果满意为48例,不满意7例,总体满意率为87.3%。NSM手术组患者满意率为94.7%(满意36例,不满意2例)。SSM手术组患者对重建乳房满意率达70.6%(满意12例,不满意5例)两组患者术后满意率相比较差异有显著性差异,具有统计学意义,经卡方检验P=0.024。结论1、对于早期乳腺癌,尤其是低复发风险和预后好的患者可以选择CM手术,预后是安全的;2、CM术和MRM术组相比较,CM术并不增加乳腺癌患者术后并发症率、局部复发率、远处转移率,CM术后能保留乳房外形,患者满意度高,特别适合中小及轻中度下垂乳房的女性患者;3、NSM手术组和SSM手术组相比较,NSM组患者对重建乳房的满意度更高,美容效果更好;4、CM手术后即刻LDMF乳房重建成功率高,术后并发症率低。但背阔肌组织量有限,不适合大、中重度下垂乳房患者的重建。
[Abstract]:Objective to analyze the feasibility and safety of conservative mastectomy and immediate breast reconstruction in the treatment of early breast cancer.Methods from December 2012 to February 2017, the rate of postoperative complications, local recurrence and distant metastasis of patients with early breast cancer treated by conservative mastectomy and immediate breast reconstruction in the first affiliated Hospital of Guangxi Medical University were analyzed retrospectively.The 3-year survival rate was compared with that of the patients with modified radical mastectomy (MRM).The satisfaction with breast reconstruction was compared between nipple-constricted mastectomy (NSM) and skin-preserving mastectomy (SSM).Results A total of 17 cases were performed CM operation, including 5 cases of prosthetic breast reconstruction, 12 cases of autologous reconstruction of pedicled latissimus dorsi myocutaneous flap and 23 cases of prosthetic breast reconstruction in 40 cases of NSM.Two of them underwent contralateral mastectomy and reconstruction with pedicled latissimus dorsi myocutaneous flap in 15 cases. There was no significant difference in postoperative complication rate between the operation of pedicled latissimus dorsi myocutaneous flap and MRM.The 3-year survival rate was 100% in both groups. There was no significant difference in recurrence, metastasis rate and survival rate within 3 years after operation. After chi-square test, 48 cases were satisfied with breast reconstruction and 7 cases were not satisfied with the cosmetic effect of breast reconstruction.The overall satisfaction rate was 94.7in 87.3%.NSM group (36 cases satisfactory, 2 cases unsatisfactory, 70.6%) (12 cases satisfactory and 5 cases unsatisfactory). There was a significant difference between the two groups.It has statistical significance, P0. 024 by chi-square test.Conclusion 1. For early breast cancer, especially for patients with low risk of recurrence and good prognosis, CM operation is safe. Compared with MRM group, CM operation does not increase the rate of postoperative complications and local recurrence of breast cancer.The distant metastasis rate (CM) could preserve the shape of the breast after operation, and the patients' satisfaction was high. It was especially suitable for the female patients with moderate or moderate prolapse of breast. The patients in the SSM group were more satisfied with the breast reconstruction than those in the control group.The cosmetic effect was better. The success rate of immediate LDMF breast reconstruction was high and the postoperative complication rate was low.But latissimus dorsi tissue is limited, not suitable for large, moderate and severe prolapse breast reconstruction.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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