乳房成形、非乳房成形和假体重建在乳腺象限或大区段切除术中效果对比观察

Comparative observation of the effects of mammaplasty,non mammaplasty and prosthesis reconstruction in the treatment of quadrant or massive mastectomy

目的 对比乳房成形、非乳房成形和假体重建在乳腺象限或大区段切除术中应用效果方法 选取2015年2月至2016年12月在我院行乳腺象限或大区段切除术的120例患者进行研究.将患者分为3组,乳房成形组48例,非乳房成形组40例和假体重建组32例.乳房成形组患者仅行乳腺大区段或象限切除术,乳房成形组术后应用侧胸壁脂肪筋膜瓣乳房修复整形,假体重建组患者术后应用毛面硅胶假体植入.记录3组患者的一般手术情况,包括手术时间、引流管留置时间、住院时间及术后住院时间等.并比较3组患者的术后乳房重建满意度和并发症发生情况.结果 乳房成形组、非乳房成形组、假体重建组的手术时间分别为（71.5±18.4）、（55.9±14.3）、（89.7±21.3）min,3组比较差异有统计学意义（F=31.32,P〈0.01）,乳房成形组的手术时间长于非乳房成形组但短于假体重建组,差异有统计学意义（P均〈0.05）;假体重建组的住院时间和术后住院时间分别为（13.7±3.4）d和（10.9±2.6）d,乳房成形组分别为（11.4±2.2）d和（8.6±1.9）d,非乳房成形组分别为（11.3±2.0）d和（8.0±1.8）d,3组比较差异均有统计学意义（F值分别为10.20、18.88,P均〈0.01）.假体重建组的住院时间、术后住院时间均显著长于乳房成形组以及非乳房成形组,差异均有统计学意义（P均〈0.05）.3组患者的引流管留置时间比较接近.乳房成形组、假体重建组、非乳房成形组总体满意度分别为（9.2±0.8）、（9.1±0.6）、（7.9±1.3）分,3组比较差异有统计学意义（F=23.22,P〈0.01）,乳房成形组和假体重建组的乳房重建满意度相当,均高于非乳房成形组,差异均有统计学意义（P均〈0.05）.乳房成形组、非乳房成形组和假体重建组患者创面感染发生率分别为10.4%（5/48）、10.0%（4/40）和6.3%（2/32）,差异无统计学意义（χ2=1.29,P=0.08）.结论 在乳腺象限或大区段切除术中,侧胸壁脂肪筋膜瓣乳房修复整形操作简单,修复效果好,安全性高,可临床推广.

Objective To compare the effects of mammaplasty, non mammaplasty and prosthesis reconstruction in the treatment of quadrant or massive mastectomy. Methods One hundred and twenty patients with segmental or quadrant mastectomy in the First People′s Hospital of Huizhou from February 2015 to December 2016 were selected for the study. The patients were divided into three groups：the mammaplasty group （48 cases）,the non mammaplasty group （40 cases）,and the prosthesis reconstruction group （32 cases）. The patients in the mammaplasty group were treated with quadrant or massive mastectomy, patients in the non mammaplasty group were treated with chest wall fat fascia flap and the prosthesis reconstruction group was treated with the application of the skin flap of the lateral chest wall. The general operation situation of the three groups were recorded,including operation time,indwelling time of drainage tube,hospitalization time and postoperative hospitalization time. The satisfaction and complications of breast reconstruction were compared among the three groups. Results The operation time of the mammaplasty group, non mammaplasty group and prosthesis reconstruction group were （71. 5±18. 4） min,（55. 9±14. 3） min and （89. 7±21. 3） min respectively,there was significant difference among the three groups （F=31.32,P〈0.01）.The operation time of the mammaplasty group was longer than that of the non mammaplasty group, but less than that of the prosthetic reconstruction group, the difference was statistically significant （ P〈 0. 05 ） . The hospitalization time and postoperative hospitalization time in the prosthesis reconstruction group were （ 13. 7 ± 3. 4 ） d and （ 10. 9 ± 2. 6 ） d, mammaplasty group （11. 4±2. 2） d and （8. 6±1. 9） d respectively,non mammaplasty group （11. 3±2） d and （8±1. 8） d respectively. The differences among the 3 groups were statistically significant （F=10. 20,18. 88,P 〈0. 01） . The postoperative hospitalization time of the prosthesis group was significantly longer than those in the other two groups （ P〈0. 05） . The indwelling time of the drainage tube was close in the 3 groups. The overall satisfaction of breast reconstruction in the mammaplasty group, non mammaplasty group and the prosthesis reconstruction group were respectively （ 9. 2 ± 0. 8 ） points, （ 9. 1 ± 0. 6 ） points, （ 7. 9 ± 1. 3 ） points, and the difference was statistically significant （ F=23. 22,P〈0. 01） . The satisfaction degrees of breast reconstruction in the mammaplasty group and the prosthesis reconstruction group were equal, higher than that in the non mammaplasty group,the differences were statistically significant （ P〈0. 05） . The incidence of wound infection in the mammaplasty group, non mammaplasty group and prosthesis reconstruction group were 10. 4% （ 5/48 ） , 10. 0% （4/40） and 6. 3% （2/32）,respectively,the difference was not statistically significant （χ2=1. 29,P=0. 08） . Conclusion In quadrant or massive mastectomy,lateral chest wall fat fascia flap has simple operation and high safety,and the restoration effect is good,which can be widely used in clinical practice.