乳腺癌乳房切除术后立即乳房重建的肿瘤学安全性的系统评价

发布时间：2018-04-05 01:22

本文选题：乳腺癌　切入点：乳房重建　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:通过系统的回顾国内外已发表的所有文献,综合性的探讨乳腺癌患者,乳房切除术后乳房重建的安全性和必要性,比较单纯乳腺癌乳房切除术患者和乳腺癌切除术后立即重建患者的5年无病生存率(DFS)、总生存率(OS)是否存在统计学差异,了解乳腺癌患者乳房切除术后,立即进行乳房再造重建对病人的预后有无影响。方法:以“乳腺癌”“重建”为中文检索词,以“Breast Neoplasms‖、 breest cancer‖、 Mammaplasty‖ breast reconstruction‖为英文检索词,通过检索PubMed、Embase、Cochrane及万方数据库中2006至今国内外公开发表的关于乳腺癌乳房切除术后乳房重建方面相关的文献,采用Cochrane协作网提供的RevMan 5.2系统软件,对符合纳入标准要求的研究进行荟萃分析和系统评价。结果:最终纳入7篇英文文献,1篇中文文献,8篇文献均为回顾性研究,其中6篇独立的研究小组的队列研究,总人数为2858例,术后立即重建组为1265例,单纯乳房切除术组为1593例。从纳入文献来看,乳腺癌切除术后重建的患者相对年龄小于单纯乳房切除手术的患者,乳腺癌分期可为初期、中期和晚期患者,随访时间均大于1年,而大部分的患者都经过了辅助治疗,乳腺癌的重建方式大体可分为自体和异体两种,自体大多选用局部肌皮瓣进行移植,常用的手术方式如腹直肌肌皮瓣、背阔肌肌皮瓣、臀大肌肌皮瓣,而异体重建可分为组织扩张器和假体两种形式。两组5年无病生存率比较,合并统计量OR=1.32,其95%置信区间(95%CI:0.96,1.82),该OR值无统计学意义,即重建组与单纯乳房切除术组相比5年无病生存率无统计学差异(P=0.09),两组5年总生存率比较,其合并统计量OR=1.36其95%可信区间(95%CI:0.86,2.14),该OR值无统计学意义,即,重建组与单纯乳房切除术组5年OS无统计学差异(P=0.19)。结论:这项系统评价表明乳腺癌术后乳房立即重建与单纯的乳腺癌切除手术相比其5年无病生存率和总生存率均无统计学差异,乳腺癌切除术后立即乳房重建不降低患者五年生存率,是一项安全可行的治疗措施。
[Abstract]:Objective: to investigate the safety and necessity of breast reconstruction in patients with breast cancer after mastectomy by systematically reviewing all the literatures published at home and abroad.The 5-year disease-free survival rate and overall survival rate of breast cancer patients undergoing mastectomy and immediate reconstruction after mastectomy were compared statistically.Immediate breast reconstruction has an impact on the prognosis of patients.Methods: using "breast cancer" and "reconstruction" as Chinese key words, "Breast Neoplasms", "breest cancer", "Mammaplasty" and "breast reconstruction" as English key words.By searching the published literatures on breast reconstruction after mastectomy in the database of PubMedus Embase Cochrane and Wanfang from 2006 to now, the RevMan 5.2 system software provided by Cochrane Cooperative Network was used.Meta-analysis and systematic evaluation of studies that meet the requirements of inclusion criteria.Results: all of the 7 English articles and 1 Chinese literature were included in the retrospective study. Among them, 6 independent study group cohort studies were conducted in 2858 patients and 1265 patients in the immediate postoperative reconstruction group.There were 1593 cases in simple mastectomy group.According to the literature, the patients with reconstruction after breast cancer resection were less than those with simple mastectomy. The stage of breast cancer was early, middle and late, and the follow-up time was more than one year.Most of the patients were treated with adjuvant therapy. The reconstruction of breast cancer can be divided into two types: autologous and allogeneic. The local myocutaneous flap is mostly used for autotransplantation. The commonly used surgical methods are rectus abdominis myocutaneous flap, latissimus dorsi myocutaneous flap.Gluteus maximus myocutaneous flap can be divided into two types: tissue dilator and prosthesis.The 5-year disease-free survival rate of the two groups was significantly higher than that of the simple mastectomy group (P < 0.09), and the 95% confidence interval of 95% confidence interval was 95% CI: 0.96 and 1.82%. There was no significant difference in the 5-year disease-free survival rate between the reconstruction group and the simple mastectomy group, and the 5-year overall survival rate between the two groups was higher than that in the simple mastectomy group.The combined statistic (OR=1.36) and 95% CI (95% CI) showed that there was no significant difference in the OR between the reconstruction group and the simple mastectomy group (P < 0. 19).Conclusion: this systematic evaluation showed that there was no significant difference in 5-year disease-free survival rate and overall survival rate between immediate breast reconstruction and simple breast cancer resection.Immediate breast reconstruction after resection of breast cancer does not reduce the 5-year survival rate, which is a safe and feasible treatment.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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