即刻假体重建、即刻背阔肌重建在保留乳头乳晕乳房切除术的应用

发布时间：2018-06-23 22:37

本文选题：乳腺癌 + 保留乳头乳晕皮下乳房切除　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的:探讨即刻假体重建(Immediate Prosthesis Reconstruction,IPR)、即刻背阔肌重建(Immediate Latissimus Dorsi Myocutaneous Flap Reconstruction,ILDMFR)在保留乳头乳晕乳房切除术(Nipple-Sparing Mastectomy,NSM)中对乳腺癌治疗的应用价值及美容效果。方法:对蚌埠医学院第一附属医院肿瘤外科2012年1月至2016年1月期间,32例保留乳头乳晕乳房切除术加即刻假体重建或即刻背阔肌重建的早期乳腺癌患者临床资料进行回顾性分析,并通过电话和门诊的随访方式,评估两种术式的应用价值及美容效果。结果:搜集2012年1月至2016年1月,32例NSM plus IPR或NSM plus ILDMFR的早期乳腺癌患者临床资料,其中背阔肌组18例,假体组14例。背阔肌组年龄为(22~64)岁,平均年龄(41.00±9.65)岁,中位年龄42岁;假体组年龄为(28~56)岁,平均年龄(40.79±8.52)岁,中位年龄41岁。背阔肌组手术时间(180~326)分钟,平均(223.89±40.28)分钟,术后住院时间(6~14)天,平均住院(8.61±2.33)天,住院费用(13589~18924)元,平均花费(15938.89±1723.67)元。假体组手术时间(170~340)分钟,平均(202.64±48.10)分钟,术后住院时间(6~12)天,平均住院(7.79±1.58)天,住院费用(18254~24032)元,平均花费(20223.86±1741.01)元。术后并发症:背阔肌组1例出现局部皮瓣缺血坏死,2例发生皮下血清肿,1例再造乳房萎缩。假体组出现包膜挛缩1例,乳头缺血1例,局部感染1例。术后美学评价:背阔肌组优良率为88.89%(16/18),假体组优良率85.71%(12/14)。患者均生存,背阔肌组1例发生骨转移,均无局部复发,无其他术后并发症。两者在术后并发症发生率和美容效果上无明显差异(P0.05);NSM plus IPR在手术时间和住院天数上用时较少,两者存在差异(P0.05);NSM plus ILDMFR费用低廉,具有经济优势,两者存在显著差异(P0.05)。结论:对于选择合适的病人NSM plus IPR或NSM plus ILDMFR是安全可靠的,二者在安全性及美容效果上无显著差别。IPR的优势是方法简单,具有手术创伤小、术后恢复快等诸多优点。NSM plus ILDMFR的成本较低,技术简单,更符合我国国情。对于合适的患者两者都值得进一步推广。
[Abstract]:Objective: to investigate the value of immediate Prosthesis reconstruction (IPR) and immediate latissimus Dorsi Myocutaneous flap reconstruction (ILDMFR) in the treatment of breast cancer during Nipple-Sparing mastectomy (NSM). Methods: from January 2012 to January 2016, 32 cases of early breast cancer with nipple-preserving areola mastectomy plus immediate prosthesis reconstruction or immediate latissimus dorsi reconstruction were retrospectively analyzed in the oncology surgery of the first affiliated Hospital of Bengbu Medical College. For retrospective analysis, The application value and cosmetic effect of the two operations were evaluated by telephone and outpatient follow-up. Results: from January 2012 to January 2016, the clinical data of 32 patients with early breast cancer of NSM plus IPR or NSM plus ILDMFR were collected, including 18 cases in latissimus dorsi group and 14 cases in prosthesis group. In latissimus dorsi group, the average age was (41.00 卤9.65) years, the median age was 42 years old, and in the prosthesis group, the age was (280.79 卤8.52) years, with a median age of 41 years. In the latissimus dorsi group, the operation time was (180 卤40.28) minutes, the average time was (223.89 卤40.28) minutes, the postoperative hospitalization time was (6 ~ 14) days, the average hospital stay was (8.61 卤2.33) days, the hospitalization cost was (13589 ~ 18924) yuan, the average cost was (15938.89 卤1723.67) yuan. In the prosthesis group, the operation time was (170 ~ 340) minutes, the average time was (202.64 卤48.10) minutes, the postoperative hospitalization time was (6 ~ 12) days, the average hospital stay was (7.79 卤1.58) days, the hospitalization cost was (1 8254 ~ 24032) yuan, the average cost was (20223.86 卤1741.01) yuan. Postoperative complications: 1 case of latissimus dorsi group showed ischemic necrosis of local flaps 2 cases of subcutaneous serum swelling 1 case of reconstruction of breast atrophy. In the prosthesis group, capsule contracture occurred in 1 case, nipple ischemia in 1 case and local infection in 1 case. Postoperative aesthetic evaluation: the excellent and good rate of latissimus dorsi group was 88.89% (16 / 18), and that of prosthesis group was 85.71% (12 / 14). In latissimus dorsi group, bone metastasis occurred in 1 case, no local recurrence and no other postoperative complications. There was no significant difference in the incidence of postoperative complications and cosmetic effect between the two groups (P0.05). There was a significant difference between the two groups in the operation time and the length of stay (P0.05). (P0.05) the cost of NSM plus ILDMFR was lower than that of the latter (P0.05), and there was a significant difference between the two groups (P0.05). Conclusion: it is safe and reliable to select suitable patients with NSM plus IPR or NSM plus ILDMFR. There is no significant difference in safety and beauty effect between them. The cost of NSM plus ILDMFR is lower, the technology is simple, and it is more suitable for our country. Both are worthy of further promotion for appropriate patients.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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