放疗对乳腺癌患者行分期即刻乳房再造的影响

Effect of radiotherapy on immediate breast reconstruction in patients with breast cancer

目的探讨术后放疗对乳腺癌患者行分期即刻乳房再造的影响。方法选择因乳腺癌接受分期即刻乳房再造的患者72例，分为放疗组和对照组，每组36例，放疗组为全乳腺切除后一期扩张器植入，在二期假体置换前接受放疗；对照组为没有接受术后放疗的患者。比较放疗组和对照组患者术后早期和晚期并发症。结果早期并发症：放疗组和对照组患者放疗前并发症比较差异未见统计学意义（P〉0.05）。晚期并发症：放疗组切口愈合不良比例为19.4%（7/36），对照组没有患者出现切口愈合不良，两组比较差异有统计学意义（P＝0.017）；两组患者扩张器移位、包囊组织不足、血清肿、感染以及Ⅲ/Ⅳ度包膜挛缩的发生率比较差异未见统计学意义（P〉0.05）。结论放疗会显著增加分期即刻乳房再造患者术后晚期并发症切口愈合不良的发生率，但没有增加其他并发症并的发生率，所以一期扩张器植入、放疗后再接受二期假体再造是Ⅱ、Ⅲ期乳腺癌患者合理的乳房再造方法。

Objective To investigate the effect of postoperative radiotherapy on breast cancer patients with immediate breast reconstruction. Methods Seventy-two patients with breast cancer under- went immediate breast reconstruction by stage of breast cancer were divided into 36 patients in the radio- therapy group and the control group, the radiotherapy group was implanted with a dilator after total mas- tectomy and received radiotherapy before the two prosthesis replacement; the control group did not receive postoperative radiotherapy. The early and late postoperative complications in the radiotherapy group and the control group were compared. Results Early complications： there was no significant difference be- tween the radiotherapy group and the control group before the radiotherapy （ P 〉 0. 05 ）. Late complica- tions： the incidence of bad wound healing in the radiotherapy group was 19.4% （7/36） , and no wound healing occurred in the control group. The difference between the two groups was significant （P = 0. 017 ）. There was no significant difference in the incidence of dilator displacement, cystic tissue defi- ciency, seroma, infection Ⅲ/Ⅳ degree capsule contracture between the two groups （P 〉 0. 05）. Conclusions Radiotherapy can significantly increase the incidence of late complications and poor wound healing after immediate breast reconstruction, but it does not increase the incidence of other complica- tions, therefore, one stage dilator implantation and two prosthesis reconstruction after radiotherapy are the rational methods of breast reconstruction for patients with ⅡandⅢ breast cancer.