乳腺癌全腺体切除术后即刻乳房重建的临床研究

发布时间：2018-06-18 23:19

本文选题：乳腺癌 + 全乳腺切除术　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨乳腺癌全腺体切除术后即刻乳房重建在乳腺癌治疗中临床意义。方法:1.共入选2008年01月~2015年12月期间在广西医科大学附属肿瘤医院接受手术治疗的183例乳腺癌患者,研究组为行乳腺癌全乳腺切除术+前哨淋巴结活检(SLNB)/腋窝淋巴结清扫术(ALND)+即刻乳房重建的96例患者,其中乳房重建包括假体49例,背阔肌肌皮瓣29例,假体联合背阔肌皮瓣4例,腹直肌肌皮瓣14例。对照组为行乳腺癌全乳腺切除术+SLNB/ALND的87例乳腺癌患者。2.收集乳腺癌患者的相关资料,对比研究组与对照组乳腺癌患者5年复发率、远处转移率、无瘤生存率、总生存率、术后美容效果及术区愈合情况、术后并发症发生率。3.统计学处理采用SPSS 21.0软件。计数资料采用百分数表示,两组之间的差异采用卡方检验。5年复发转移率、无瘤生存率和总生存率等的计算运用Kaplan-Meier法,两组之间5年复发转移率、无病生存率和总生存率等的比较采用log-rank检验。计量资料数据采用均数±标准差((?)±s表示,两组间比较采用独立样本t检验。对5年生存率进行单因素分析,对无瘤生存时间进行COX回归模型(Backward Wald)多因素分析,对患者年龄、绝经情况、肿瘤分期、免疫组化等因素进行COX风险回归分析。对与并发症可能相关的因素纳入Logistic回归模型进行多因素分析。以P0.05为差异有统计学意义。乳房重建组术后美学满意度评估参照Harris评价标准。结果:研究组与对照组的中位随访时间分别是69个月和58个月。1、研究组5年内有1例出现局部复发,对照组5年内有3例患者出现局部复发,研究组与对照组5年局部复发率分别是1.0%及3.4%,差异无统计学意义(P=0.537);研究组5年内出现2例区域淋巴结转移,对照组5年内出现1例区域淋巴结转移,研究组与对照组5年区域淋巴结转移率分别是2.1%及1.2%,差异无统计学意义(P=1.000);5年远处转移率分别是5.2%及10.3%,差异无统计学意义(P=0.184);5年无瘤生存率分别是91.7%及85.1%,两者比较无统计学差异(P=0.135);5年总生存率分别是97.9%及98.9%,差异无统计学意义(P=0.695)。2、研究组术后美学满意度Harris评价优良率为90.5%。3、研究组术后拔管时间5~113天,中位拔管时间为13天,对照组术后拔管时间5~71天,中位拔管时间为9天,两者间比较差异有统计学意义(P=0.001);研究组术后切口愈合时间6~141天,中位愈合时间13.5天,对照组术后切口愈合时间6~74天,中位愈合时间10天,两者间比较差异有统计学意义(P=0.005)。4、术后并发症:研究组术后总并发症为20.8%,12例出现背部血清肿,1例皮瓣感染,2例局部皮瓣坏死,2例脂肪液化,3例切口部分裂开,2例皮瓣萎缩,1例腹壁疝;对照组术后总并发症为8.1%,其中4例皮下积液,1例乳头乳晕坏死,1例切缘皮肤坏死,2例切口裂开并予以II期缝合。两组间比较差异有统计学意义(P=0.016)。结论:乳腺癌全腺体切除术后即刻乳房重建与单纯全乳腺切除术相比局部区域复发率、远处转移率增高,无瘤生存率、总生存率没有下降。另外,即刻乳房重建术后美容效果较好,但术后切口愈合时间相对较长,术后并发症发生率相对增加。
[Abstract]:Objective: To explore the clinical significance of immediate breast reconstruction after total glandular resection of breast cancer in the treatment of breast cancer. Methods: 1. a total of 183 breast cancer patients received surgical treatment at the Affiliated Cancer Hospital of Guangxi Medical University from 01 months of 2008 to December ~2015 were selected for breast cancer total mammary resection plus sentinel lymph node biopsy (SLNB). 96 patients with axillary lymph node dissection (ALND) + immediate breast reconstruction, including 49 cases of prosthesis, 29 cases of latissimus dorsi myocutaneous flap, 4 cases of prosthesis combined with latissimus dorsi flap, 14 cases of rectus abdominis myocutaneous flap, and 87 cases of breast cancer with breast cancer total mammary resection,.2. collection of breast cancer patients were collected. The 5 year recurrence rate, distant metastasis rate, tumor free survival rate, total survival rate, postoperative beauty effect and healing condition were compared between the study group and the control group. The incidence of postoperative complications was treated with SPSS 21 software.3.. The count data were expressed as percentage points, and the difference between the two groups was detected by chi square test for the recurrence rate of.5 years. The Kaplan-Meier method was used to calculate the tumor survival rate and total survival rate. The 5 year recurrence rate, the disease free survival rate and the total survival rate between the two groups were compared with the log-rank test. The data data were compared with the mean + standard deviation (?) + s, and the two groups were compared with the independent sample t test. The single factor analysis of the 5 year survival rate was performed on no tumor. Multiple factors analysis of COX regression model (Backward Wald) was carried out for the survival time. COX risk regression analysis was performed on patients' age, menopause, tumor staging, immunohistochemistry. The factors associated with the complications were included in the multifactor analysis of the Logistic regression model. The difference of P0.05 was statistically significant. The postoperative beauty of the breast reconstruction group was beautiful. The study group and the control group were followed up for 69 months and 58 months.1 respectively. The study group had 69 months and 58 months respectively, and the study group had local recurrence in 5 years, and 3 patients in the control group had local recurrence within 5 years. The local recurrence rate of the study group and the control group was 1% and 3.4%, respectively, and the difference was not statistically significant. P=0.537); in the study group, there were 2 cases of regional lymph node metastasis in 5 years and 1 cases of regional lymph node metastasis in the control group in 5 years. The regional lymph node metastasis rate in the study group and the control group was 2.1% and 1.2%, respectively (P=1.000), and the distant metastasis rate of 5 years was 5.2% and 10.3%, respectively (P=0.184), and there was no tumor in 5 years. The survival rate was 91.7% and 85.1% respectively (P=0.135); the total survival rate of 5 years was 97.9% and 98.9% respectively, the difference was not statistically significant (P=0.695).2. The excellent rate of aesthetic satisfaction Harris in the study group was 90.5%.3, the postoperatively extubation time of the study group was 113 days, the median extubation time was 13 days, and the control group after operation time 5~7 was 5~7. 1 days, the median extubation time was 9 days, there was a significant difference between the two (P=0.001). The healing time of the incision was 6~141 days, the median healing time was 13.5 days, the healing time of the incision was 6~74 days and the median healing time was 10 days in the control group, and the difference was statistically significant (P=0.005).4. The postoperative complications: postoperative complications: total postoperative complications in the study group. The complications were 20.8%, 12 cases with back serum swelling, 1 cases of skin flap infection, 2 cases of local flap necrosis, 2 cases of fat liquefaction, 3 cases of partial cleaved incision, 2 cases of atrophy of skin flap, 1 cases of abdominal wall hernia, and 4 cases of subcutaneous effusion, 1 cases of nipple areola, 1 cases of cutting edge skin necrosis, 2 cases of incision split and II suture. The difference between the two groups was statistically significant (P=0.016). Conclusion: the local recurrence rate, the distant metastasis rate, the tumor free survival rate and the total survival rate were not decreased in the immediate breast reconstruction after total glandular resection of breast cancer, and the total survival rate was not decreased. Relatively long, the incidence rate of postoperative complications increased.
【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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