关于即刻乳房重建术安全性及其相关并发症的探讨

发布时间：2019-06-13 07:22

【摘要】：目的随着女性对美观的追求,越来越多的患者在乳腺癌改良根治术后选择乳房重建。本研究的目的是探讨即刻乳房重建术安全性及其相关的并发症。方法本研究对天津医科大学肿瘤医院2011年1月份至2012年12月份收治的223例经病理诊断为乳腺癌的患者进行回顾性分析。计数资料的比较采用χ2检验或确切概率法,计量资料的比较采用t检验或Mann-Whitney检验,定义P值小于0.05认为具有统计学意义。结果将患者分为即刻重建术组(n=108例)和改良根治术组(n=115例)。即刻重建术组和改良根治术组的中位术后辅助化疗开始时间分别为21天和11天,差异有统计学意义(P0.001),但并没有患者超过12周。在并发症发生率方面,即刻重建术组血肿的发生率比改良根治术组低,差异有统计学意义(P0.05)。但即刻重建术组患者中二次手术以及脂肪坏死的发生率均比改良根治术组高,差异均有统计学意义(P0.05),而即刻重建术组感染的发生率比改良根治术组高,但差异无统计学意义(P0.05)。在108例接受即刻乳房重建的患者中,有22例患者接受了术后放疗,行术后放疗的患者二次手术的发生率比未行放疗的患者高,差异有统计学意义(P0.05)。且行术后放疗的患者对术后美容效果的满意率低于未行术后放疗的患者,差异有统计学意义(P0.05)。在108例患者中,有65例患者应用自体组织重建,其中有12例患者接受了术后放疗。在应用自体组织重建的患者中,行术后放疗的患者,其二次手术和皮瓣坏死的发生率均比未行放疗的高,但差异无统计学意义(P0.05)。但术后放疗的患者脂肪坏死发生较未行放疗组高,且差异有统计学意义(P0.05)。而两组患者在美容效果方面差异无统计学意义(P0.05)。在108例患者中,有43例患者应用假体重建,其中有10例患者接受了术后放疗。行术后放疗的患者,其扩张器/假体外露、包膜挛缩及二次手术的发生率均比未行放疗者高,且差异均有统计学意义(P0.05)。同时,行术后放疗的患者美容效果满意度比未行放疗者低,且差异有统计学意义(P0.05)。结论相对于改良根治术而言,即刻乳房重建会使患者术后辅助化疗开始时间延长,但没有患者超过12周,不会影响患者的预后,因此没有显著的临床意义。即刻重建术组患者二次手术和脂肪坏死的发生率均明显高于改良根治术组。总的来说,术后放疗会使即刻乳房重建患者二次手术发生率显著增加,同时使其美容效果满意度显著降低。但对于自体组织重建而言,放疗仅会使其脂肪坏死的发生率显著增加。而对于假体重建,放疗会使其扩张器/假体外露、包膜挛缩、二次手术等并发症发生率明显增加,而美容效果满意度显著降低。
[Abstract]:Objective with the pursuit of beauty in women, more and more patients choose breast reconstruction after modified radical mastectomy. The purpose of this study was to investigate the safety of immediate breast reconstruction and its related complications. Methods 223 patients with breast cancer diagnosed pathologically from January 2011 to December 2012 in Cancer Hospital of Tianjin Medical University were analyzed retrospectively. The comparison of counting data was carried out by 蠂 2 test or exact probability method, and t test or Mann-Whitney test was used to compare the measured data. It was considered statistically significant that the P value was less than 0.05. Results the patients were divided into immediate reconstruction group (n = 108) and modified radical operation group (n = 115). The median postoperative adjuvant chemotherapy time in immediate reconstruction group and modified radical operation group was 21 days and 11 days, respectively, the difference was statistically significant (P0.001), but no patients were more than 12 weeks. In terms of the incidence of complications, the incidence of hematomas in the immediate reconstruction group was lower than that in the modified radical operation group, the difference was statistically significant (P 0.05). However, the incidence of secondary operation and fat necrosis in immediate reconstruction group was higher than that in modified radical operation group, the difference was statistically significant (P 0.05), but the incidence of infection in immediate reconstruction group was higher than that in modified radical operation group, but the difference was not statistically significant (P 0.05). Of the 108 patients who received immediate breast reconstruction, 22 patients received postoperative radiotherapy. The incidence of secondary surgery in patients undergoing postoperative radiotherapy was significantly higher than that in patients without radiotherapy (P 0.05). The satisfaction rate of postoperative radiotherapy patients was lower than that of patients without postoperative radiotherapy, the difference was statistically significant (P 0.05). Of the 108 patients, 65 were treated with autologous tissue reconstruction, and 12 of them received postoperative radiotherapy. In the patients with autologous tissue reconstruction, the incidence of secondary surgery and flap necrosis in patients undergoing postoperative radiotherapy was higher than that without radiotherapy, but the difference was not statistically significant (P 0.05). However, the incidence of fat necrosis in patients treated with postoperative radiotherapy was higher than that in patients without radiotherapy, and the difference was statistically significant (P 0.05). However, there was no significant difference in cosmetic effect between the two groups (P 0.05). Of the 108 patients, 43 were treated with artificial reconstruction, and 10 of them received postoperative radiotherapy. The incidence of dilator / prosthesis exposure, capsule contracture and secondary operation in patients undergoing postoperative radiotherapy was higher than that in patients without radiotherapy, and the difference was statistically significant (P 0.05). At the same time, the cosmetic effect satisfaction of patients treated with postoperative radiotherapy was lower than that of patients without radiotherapy, and the difference was statistically significant (P 0.05). Conclusion compared with modified radical mastectomy, immediate breast reconstruction can prolong the start time of postoperative adjuvant chemotherapy, but no patient has more than 12 weeks, which will not affect the prognosis of patients, so it has no significant clinical significance. The incidence of secondary operation and fat necrosis in immediate reconstruction group was significantly higher than that in modified radical operation group. In general, postoperative radiotherapy can significantly increase the incidence of secondary surgery in patients with immediate breast reconstruction, and significantly reduce the satisfaction of cosmetic effect. However, for autologous tissue reconstruction, radiotherapy only significantly increased the incidence of fat necrosis. For the reconstruction of the prosthesis, radiotherapy can significantly increase the incidence of complications such as dilator / prosthesis exposure, capsule contracture, secondary operation and so on, while the satisfaction of cosmetic effect is significantly decreased.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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