乳腺癌术后即刻乳房重建与单纯改良根治术效果比较

Efficacy comparison of immediate breast reconstruction after breast cancer surgery and modified radical mastectomy

目的探讨乳腺癌患者术后采用两种即刻乳房重建方法和单纯改良根治术的临床疗效及美容效果.方法回顾性分析锦州医科大学附属第一医院2014年10月至2018年9月收治的95例早期乳腺癌患者临床资料,根据治疗方法分为背阔肌联合假体再造组(27例)、钛网补片联合假体再造组(18例)和单纯改良根治术组(50例).比较三组患者的手术资料、术后并发症及术后生命质量之间的差异,并观察不同重建组之间术后美容效果.结果三组患者引流时间、术中出血量比较,差异均无统计学意义(均P>0.05),住院时间、术后生命质量评分比较,差异均有统计学意义(均P<0.01).背阔肌联合假体再造组、钛网补片联合假体再造组与单纯改良根治术组并发症发生率分别为48.1%(13/27)、22.2%(4/18)、12.00%(6/50),其中背阔肌联合假体再造组与单纯改良根治术组之间差异有统计学意义(χ^2=12.33,P<0.01).钛网补片联合假体再造组术后美容效果优良率[81.5%(22/27)]与背阔肌联合假体再造组[83.3%(15/18)]比较,差异无统计学意义(χ^2=0.025,P>0.05).结论在适应证基础上,乳腺癌术后采取背阔肌或钛网补片联合假体行即刻乳房重建均能提高患者的术后美容效果及生命质量.但两种重建术后并发症增加,应加强对患者的术后处理.

Objective To investigate the clinical efficacy and cosmetic outcome of two methods of immediate breast reconstruction and modified radical mastectomy for the patients with breast cancer after breast cancer surgery. Methods The clinical data of 95 patients with early breast cancer in the First Affiliated Hospital of Jinzhou Medical University from October 2014 to September 2018 were retrospectively analyzed. The patients were divided into latissimus dorsi combined with implants group (27 cases), titanium-coated polypropylene mesh combined with implants group (18 cases) and modified radical group (50 cases). The differences of surgical data, postoperative complications and quality of life were compared in the three groups. The postoperative cosmetic effect of two immediate reconstruction groups was observed. Results The differences of drainage duration and intraoperative blood loss in the three groups were not statistically significant (both P > 0.05). There were statistical differences in the hospital stay and the postoperative quality of life score (both P < 0.01). The incidence of postoperative complications in latissimus dorsi combined with implants group, the titanium-coated polypropylene mesh combined with implants group and the modified radical group was 48.1% (13/27), 22.2% (4/18) and 12.0% (6/50), respectively. And the difference between latissimus dorsi combined with implants group and the modified radical surgery group was statistically significant (χ 2 = 12.33, P < 0.01). The good rate of cosmetic effect in titanium-coated polypropylene mesh group was higher than that in latissimus dorsi combined with implants group, and there was no statistically significant difference [83.3% (15/18) vs. 81.5% (22/27), χ 2 = 0.025, P > 0.05]. Conclusions Immediate breast reconstruction including latissimus dorsi combined with implants or titanium-coated polypropylene mesh combined with implants after radical mastectomy on the basis of indications can improve the quality of life and the cosmetic results of patients, but postoperative treatment is necessary for the increased complications after the two reconstruction methods.