早期乳腺癌超象限切除同期背阔肌皮瓣转移乳房重建术的临床研究
发布时间：2018-10-26 16:01
【摘要】：目的 本研究通过分析早期乳腺癌患者行乳腺癌超象限切除同期背阔肌皮瓣转移乳房重建术与传统保乳治疗方式的近、远期疗效,评估乳腺癌超象限切除同期背阔肌皮瓣转移乳房重建术,术后不行放疗的可行性及美容效果。方法 分析河北大学附属医院肿瘤外科2009年5月至2013年12月行超象限切除同期背阔肌皮瓣转移乳房重建术后未行放疗患者22例(A组)及传统保乳术患者44例(B组)。对在临床上被认为对预后有重要影响变量包括乳腺癌TNM分期、腋窝淋巴结状态、雌激素受体状态、Her-2状态4个变量进行1:2配对。入组病例均有完整的临床及随访资料。所有数据采用SPSS17.0软件进行分析,对计数资料间的比较采用χ2检验,应用Kaplan-Meier法计算生存率,绘制生存曲线,采用log-rank检验比较生存曲线间差异。检验水准α=0.05,P0.05时差异有统计学意义。比较两组患者术后并发症、局部复发率、无病生存率、总生存率及术后乳房美容效果。结果 对术后乳房美容效果的主观满意度调查结果显示,A组患者术后对乳房美观的总满意率为81.8%(18/22)。B组患者术后对乳房美观的总满意率为86.4%(38/44)。两组之间对比差异无统计学意义(P0.05)。两组手术方式并发症均较少,皮瓣坏死、切口感染、上肢水肿及功能障碍发生率差异均无统计学意义(P0.05)。A组的皮下积液发生率高于B组(P0.05)。A组的随访时限:9-62个月,中位随访时间为42个月,有1例局部复发,2例出现远处转移,均为肺转移,其中1例因转移死亡;B组的随访时限为:6-62个月,中位随访时间为38.5个月。有4例出现局部复发、3例出现了远处转移,1例为肺转移,2例为肝转移,其中2例因转移死亡。两组患者术后局部复发率、无病生存率、总生存率对比差异均无统计学意义(P0.05)。结论 我们对早期乳腺癌行乳腺肿物超象限切除,同时行腋下淋巴结清扫,因考虑残腔闭合后影响乳腺外形,术中采用整形方法,应用背阔肌皮瓣成形术对乳腺进行整形。术后患者虽未行放疗,但生存率及复发率和传统保乳术相比差异无统计学意义,同时使患者获得良好的美容效果。
[Abstract]:Objective to analyze the near and long term effects of breast reconstruction and traditional breast conserving treatment in patients with early breast cancer undergoing breast cancer superquadrant resection and latissimus dorsi flap transfer. To evaluate the feasibility and cosmetic effect of breast reconstruction with supraquadrant resection and latissimus dorsi flap transfer. Methods from May 2009 to December 2013, 22 patients (group A) without radiotherapy and 44 patients with traditional breast conserving surgery (group B) underwent supersonic quadrant resection and reconstruction of breast with latissimus dorsi flap transfer. Four variables, including breast cancer TNM stage, axillary lymph node status, estrogen receptor status, and Her-2 status, were matched at 1:2. All patients had complete clinical and follow-up data. All the data were analyzed by SPSS17.0 software, 蠂 2 test was used to compare the counting data, the survival rate was calculated by Kaplan-Meier method, and the survival curve was plotted. The difference of survival curve was compared by log-rank test. The difference was statistically significant when the test level was 伪 = 0.05 (P 0.05). The postoperative complications, local recurrence rate, disease-free survival rate, overall survival rate and postoperative breast cosmetic effect were compared between the two groups. Results the results of subjective satisfaction survey on the effect of breast beauty after operation showed that, The total satisfaction rate of breast beauty in group A was 81.8% (86.4%, 38 / 44) in group A (18 / 22). B). There was no significant difference between the two groups (P0.05). The complications of the two groups were less, skin flap necrosis, incision infection, There was no significant difference in the incidence of upper limb edema and dysfunction (P 0.05) the incidence of subcutaneous effusion in). A group was higher than that in B group (P0.05). A group: 9-62 months, median follow-up time was 42 months). Local recurrence occurred in 1 case and distant metastasis in 2 cases, in which 1 case died of metastasis. The follow-up time of group B was 6-62 months and the median follow-up time was 38. 5 months. There were 4 cases of local recurrence, 3 cases of distant metastasis, 1 case of lung metastasis and 2 cases of liver metastasis, of which 2 cases died of metastasis. There was no significant difference in local recurrence rate, disease-free survival rate and overall survival rate between the two groups (P0.05). Conclusion in the early stage of breast cancer, we performed superquadrant mastectomy and axillary lymph node dissection. Due to the influence of residual cavity closure on breast shape, we used plastic surgery and latissimus dorsi myocutaneous flap for breast reconstruction. Although the patients were not treated with radiotherapy, the survival rate and recurrence rate were not significantly different from those of traditional breast conserving surgery.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9
本文编号：2296257
[Abstract]:Objective to analyze the near and long term effects of breast reconstruction and traditional breast conserving treatment in patients with early breast cancer undergoing breast cancer superquadrant resection and latissimus dorsi flap transfer. To evaluate the feasibility and cosmetic effect of breast reconstruction with supraquadrant resection and latissimus dorsi flap transfer. Methods from May 2009 to December 2013, 22 patients (group A) without radiotherapy and 44 patients with traditional breast conserving surgery (group B) underwent supersonic quadrant resection and reconstruction of breast with latissimus dorsi flap transfer. Four variables, including breast cancer TNM stage, axillary lymph node status, estrogen receptor status, and Her-2 status, were matched at 1:2. All patients had complete clinical and follow-up data. All the data were analyzed by SPSS17.0 software, 蠂 2 test was used to compare the counting data, the survival rate was calculated by Kaplan-Meier method, and the survival curve was plotted. The difference of survival curve was compared by log-rank test. The difference was statistically significant when the test level was 伪 = 0.05 (P 0.05). The postoperative complications, local recurrence rate, disease-free survival rate, overall survival rate and postoperative breast cosmetic effect were compared between the two groups. Results the results of subjective satisfaction survey on the effect of breast beauty after operation showed that, The total satisfaction rate of breast beauty in group A was 81.8% (86.4%, 38 / 44) in group A (18 / 22). B). There was no significant difference between the two groups (P0.05). The complications of the two groups were less, skin flap necrosis, incision infection, There was no significant difference in the incidence of upper limb edema and dysfunction (P 0.05) the incidence of subcutaneous effusion in). A group was higher than that in B group (P0.05). A group: 9-62 months, median follow-up time was 42 months). Local recurrence occurred in 1 case and distant metastasis in 2 cases, in which 1 case died of metastasis. The follow-up time of group B was 6-62 months and the median follow-up time was 38. 5 months. There were 4 cases of local recurrence, 3 cases of distant metastasis, 1 case of lung metastasis and 2 cases of liver metastasis, of which 2 cases died of metastasis. There was no significant difference in local recurrence rate, disease-free survival rate and overall survival rate between the two groups (P0.05). Conclusion in the early stage of breast cancer, we performed superquadrant mastectomy and axillary lymph node dissection. Due to the influence of residual cavity closure on breast shape, we used plastic surgery and latissimus dorsi myocutaneous flap for breast reconstruction. Although the patients were not treated with radiotherapy, the survival rate and recurrence rate were not significantly different from those of traditional breast conserving surgery.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9
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