肥胖患者乳房再造手术方式和时机的探讨

Discussion of breast reconstruction surgery approach in obese patients

目的探讨在肥胖患者中,乳房再造手术方式(肌皮瓣再造或假体植入)及手术时机(即刻或延迟再造)的选择。方法回顾性分析2000年1月至2011年12月间河南省人民医院乳腺甲状腺外科行假体植入和腹直肌肌皮瓣乳房再造的肥胖病例284例。根据国际卫生组织肥胖分级:一度肥胖,体重指数,30.0～34.9kg/m2;二度肥胖,体重指数35.0～39.9kg/m2;三度肥胖,体重指数大于等于40kg/m2。观察指标为284例不同肥胖程度的患者行假体植入和腹直肌肌皮瓣乳房的总体并发症并计算分析再造失败率。结果本研究共包括284例肥胖患者的310例乳房再造手术(164例肌皮瓣再造及146例假体植入再造),中位随访时间为20个月。假体植入比肌皮瓣移植手术失败率更高(15.7%vs1.2%)。中重度肥胖患者行假体植入或肌皮瓣再造的失败率差异最为显著,其中二度肥(22.9%vs0),三度肥胖(25.0%vs0),而在一度肥胖患者中差异较小(11.0%vs1.6%)。结论肥胖患者尤其是中重度肥胖者行假体植入乳房再造的失败率更高,腹直肌肌皮瓣再造技术也许更适合这类人群;延迟手术和即刻手术总体并发症差异不具有统计学意义。

Objective Explore a better breast reconstruction surgery approach （abdominal-based free flap or implant-based） and the timing of surgery （immediate reconstruction or delayed） for obese patients.Methods The authors retrospectively analyzed implant- and abdominal-based free flap breast reconstructions performed in obese patients between January, 2000 and December, 2011 by utilizing the World Health Organization obesity classifications： class Ⅰ, 30.0 to 34.9 kg/m2 , class Ⅱ, 35.0 to 39.9 kg/m2, and class Ⅲ, 40 kg/m2. Primary outcome measures the overall complications. Results The analysis included 310 breast reconstructions （164 flaps versus 146 implants） in 284 patients. Mean follow-up was 20 months. Implants demonstrated a higher failure rate （15.7 percent） than flaps （1.2 percent）. Differences between implant versus flap reconstruction failure rates were highest among more obese patients [class Ⅱ （22.9 versus 0 percent） and class Ⅲ （25.0 versus 0 percent） compared with class Ⅰ （11.0 versus 1.6 percent）].Conclusions Obese patients （particularly class Ⅱ and Ⅲ） experience higher failure rates with implant-based breast reconstruction. Free flap techniques may be warranted in this population. There is no significant difference between immediate reconstruction or delayed in the overall complications.