环乳晕切口保留乳头的乳房切除术联合延迟即刻重建术在早期乳腺癌治疗中的临床应用

发布时间：2018-05-24 07:59

本文选题：乳腺癌 + 延迟即刻重建术　；参考：《北京协和医学院》2016年博士论文

【摘要】：第一部分环乳晕切口保留乳头的乳房切除术联合延迟即刻重建术在早期乳腺癌治疗中的临床应用目的：总结环乳晕切口保留乳头的乳房切除术联合延迟即刻重建术在早期乳腺癌治疗中的技术流程,分析此术式的主要并发症及发生原因和相应处理方法,评价该术式的临床应用价值。方法：纳入2010年1月至2015年6月期间在北京协和医院实施完成环乳晕切口保留乳头的乳房切除术联合延迟即刻重建术的57例早期乳腺癌患者进行研究。收集患者相关一般性资料及疾病资料,按照统一流程实施手术,对手术操作流程进行详尽记录,对术后并发症进行统计,分析并发症发生原因并予以相应处理,观察疗效；通过门诊随访的方式对术后患者乳房的主观、客观满意度进行调查,评价手术效果。结果：57例早期乳腺癌患者均按照流程完成手术及乳腺癌辅助治疗。术后平均随访26个月。术后并发症均发生于Ⅰ期环乳晕切口保留乳头的乳房切除术联合扩张器植入术后。主要近期并发症包括：乳头乳晕区血运障碍：乳头乳晕区部分坏死21例(36.8%)、乳头乳晕区完全坏死1例(1.8%),切口愈合不良3例,切口感染1例和皮下积液3例；远期并发症主要为扩张器植入相关并发症,包括：扩张器暴露1例,扩张器扩张失败1例以及扩张器移位6例。乳房重建术后主观满意度为优和良的占66.7%；客观满意度为优良的占71.9%,结论：对于有保乳愿望但不具备保乳条件的早期乳腺癌患者,环乳晕切口保留乳头的乳房切除切除联合延迟即刻重建术可以获得良好的美学效果及主观、客观满意度。乳头乳晕区部分坏死和扩张器植入相关并发症是该术式的主要并发症,可以通过改善手术操作及术后管理减少并发症发生。通过乳腺肿瘤外科和整形外科的紧密合作,该术式可以顺利有效的完成,可以将该术式作为中国女性早期乳腺癌患者手术治疗的重要组成部分。第二部分乳房延迟即刻重建术后乳腺癌患者的生命质量及其相关因素分析目的：了解环乳晕切口保留乳头的乳房切除术联合延迟即刻重建术后乳腺癌患者的生命质量(Quality of Life, QOL)现状并分析其影响因素,以了解此术式对患者术后QOL的影响,找到此术式的适合人群,根据相关影响因素予以针对性措施,以提高此类患者的QOL。方法：2016年1月至2016年6月于北京协和医院随访的57例环乳晕切口保留乳头的乳房切除术联合延迟即刻重建术后患者,采用FACT-B(中文版4.0版)量表对患者QOL进行调查,通过相关性分析寻找影响QOL的因素。结果：57例环乳晕切口保留乳头的乳房切除术联合延迟即刻重建术后乳腺癌患者各领域生命质量状况良好。生理状况领域评分20分～28分,平均得分25.05±1.76分；社会／家庭状况领域评分15～28分,平均得分25.02±3.28分；情感状况领域评分11～24分,平均得分18.79±3.76分；功能状况领域评分10～28分,平均得分20.96±4.56分；附加关注领域评分22-36分,平均得分29.54±2.82分；FACT-G量表总分评分65-108分,平均得分89.82±11.11分；FACT-B量表总分评分94-144分,平均得分119.37±11.79分。相关性分析中年龄增长、绝经与患者生命质量呈负相关(r0,P0.05),已婚、未育有子女、未接受内分泌治疗及术后时间延长与生命质量呈正相关(r0,P0.05)。结论:延迟即刻重建术可以使患者获得较高的的生命质量,是乳腺癌患者理想的乳房重建术式。选择适合的患者实施此手术并根据相关影响因素予以针对性干预,可以提高此类乳腺癌患者的生命质量。第三部分保乳术和延迟即刻重建术对乳腺癌患者生命质量影响的对比研究目的：比较保乳术及延迟即刻重建术对乳腺癌患者术后生命质量(QOL)的影响,为手术方式的选择提供依据。方法：2016年3月至2016年4月于北京协和医院乳腺外科门诊随访乳腺癌术后的保乳及延迟即刻重建患者共64例,其中保乳手术组30例,延迟即刻重建手术组34例。应用FACT-B量表对两组患者进行生命质量测评并予以比较。结果:保乳手术组和延迟即刻重建术组乳腺癌患者均能获得较高的QOL,FACT-B,总分分别为111.20±3.18和113.40±9.98。在生理状况、社会/家庭状况、情感状况、功能状况以及总体生命质量评价FACT-G和FACT-B方面,乳房延迟即刻重建组和保乳组比较差异无统计学意义(P0.05)；乳房延迟即刻重建组患者在附加关注(乳腺癌特异模块)方面QOL得分优于保乳术组,差异有统计学意义(29.37±2.72 vs 24.05±7.01,P0.05)。结论：乳腺癌保乳术和延迟即刻再造术术后患者均可获得良好的QOL,是保留和恢复乳腺癌术后乳房外观形态的理想手术方式。延迟即刻重建术后患者生命质量与保乳术后患者无明显差异。对于不具备保乳条件的乳腺癌患者,可以选择全乳切除术后延迟即刻重建术以获得良好的生命质量。
[Abstract]:The first part of the clinical application of the circum areola incisional papillectomy combined with delayed immediate reconstruction in the treatment of early breast cancer: a summary of the technical flow of the circum areola incisional papillectomy combined with delayed immediate reconstruction in the treatment of early breast cancer, and to analyze the major complications and the occurrence of this operation. Methods: To evaluate the clinical application value of the operation. Methods: 57 cases of early breast cancer patients were carried out in Peking Union Medical College Hospital during the period from January 2010 to June 2015. The patients with early breast cancer and delayed immediate reconstruction were carried out in Peking Union Medical College Hospital. According to the unified process, the operation was performed, the operation process was recorded in detail, the postoperative complications were counted, the causes of the complications were analyzed, and the curative effect was observed. The subjective and objective satisfaction of the breasts after the operation was investigated and the results were evaluated. The results were 57 cases. All patients were followed up for 26 months after operation. The postoperative complications occurred in stage I mastectomy combined with dilator implantation. The main recent complications included: blood transport disorders in the nipple areola area: 21 cases of nipple areola necrosis (36. 8%) 1 cases of complete necrosis of nipple areola (1.8%), 3 cases of wound healing, 1 cases of incisional infection and 3 cases of subcutaneous effusion. The long-term complications were mainly dilator implantation related complications, including 1 cases of dilator exposure, 1 dilator dilatation and 6 dilator displacement. The subjective satisfaction after breast reconstruction was 66.7%; The objective satisfaction is 71.9%. Conclusion: for breast cancer patients with breast conserving desire but not with breast conserving conditions, the mamastectomy combined with delayed immediate reconstruction of the circum areola incision retaining nipple can obtain good aesthetic effects and subjective, objective satisfaction. Partial necrosis of the nipple areola and the expander implant phase The complication is the main complication of the operation, and the complications can be reduced by improving operation and postoperative management. Through the close cooperation of breast cancer surgery and plastic surgery, the operation can be successfully completed and can be used as an important part of the surgical treatment of early breast cancer patients in Chinese women. Second Analysis of the quality of life and related factors of breast cancer patients after partial breast delayed immediate reconstruction. Objective: to understand the status of Quality of Life (QOL) in patients with breast cancer after delayed immediate reconstruction of the annular areola incision combined with delayed immediate reconstruction of breast cancer (QOL) and analyze its influencing factors in order to understand the postoperative QOL In order to improve the QOL. method of this type of patient, 57 cases of circum areola incisional papillectomy combined with delayed immediate reconstruction were treated by FACT-B (Chinese version 4 edition) in the Peking Union Medical College Hospital from January 2016 to June 2016. The QOL was investigated and the factors affecting QOL were found by correlation analysis. Results: 57 cases of breast cancer with retained nipple with circum areola incision combined with delayed immediate reconstruction of breast cancer were in good quality of life in all fields. The score of physiological status was 20 to 28 points, the average score was 25.05 + 1.76 points, and social / family shape. The field score was scored 15~28 points, the average score was 25.02 + 3.28 points, the emotional state field score was 11~24, the average score was 18.79 + 3.76 points, the functional status field score was 10~28 points, the average score was 20.96 + 4.56 points, the additional concern area score was 22-36, the average score was 29.54 + 2.82 points, the FACT-G total score 65-108 scores, the average score 89.82 + + 1.11 points, the total score of the FACT-B scale was 94-144, the average score was 119.37 + 11.79. The age increased in the correlation analysis. The menopause was negatively correlated with the quality of life (R0, P0.05), married, and had no children. The unaccepted endocrine treatment and the extension of the postoperative time were positively correlated with the quality of life (R0, P0.05). Conclusion: delayed immediate reconstruction can make it possible. Patients with high quality of life are ideal breast reconstruction procedures for breast cancer patients. Select the appropriate patients to perform this operation and targeted intervention according to the related factors to improve the quality of life of the breast cancer patients. Third the effects of breast conserving and delayed reconstruction on the quality of life of breast cancer patients Objective: To compare the effect of breast conserving and delayed immediate reconstruction on the postoperative quality of life (QOL) of breast cancer patients, and to provide the basis for the selection of surgical methods. Methods: 64 cases of breast conserving and delayed immediate reconstruction after breast cancer surgery were followed up from March 2016 to April 2016 in the breast surgery outpatient department of Peking Union Medical College Hospital. There were 30 cases in the operation group and 34 cases of delayed immediate reconstruction. The quality of life of the two groups was evaluated and compared with the FACT-B scale. Results: the breast cancer patients and the delayed immediate reconstruction group were able to obtain higher QOL, FACT-B, the total score was 111.20 + 3.18 and 113.40 + 9.98. in the physiological condition, the social / family status, There was no significant difference in FACT-G and FACT-B between the immediate reconstruction group and the breast conserving group (P0.05), and the QOL score of the breast delayed immediate reconstruction group was better than that in the breast conserving group (29.37 + 2.72 V). S 24.05 + 7.01, P0.05). Conclusion: breast conserving and delayed immediate reconstruction can obtain good QOL. It is an ideal way to retain and restore breast appearance after breast cancer operation. The quality of life after delayed immediate reconstruction is not significantly different from that after breast conserving surgery. For breast cancer patients who do not have breast conserving conditions Patients with cancer can choose immediate delayed reconstruction after total mastectomy to achieve good quality of life.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R737.9

【参考文献】