改良根治术和改良根治术后即刻背阔肌皮瓣乳房重建治疗乳腺癌患者围手术期情况和生活质量的对比研究

Comparative study on the perioperative situation and quality of life of patients with breast cancer treated by modified radical mastectomy and immediate latissimus dorsi flap breast reconstruction after modified radical mastectomy

目的对比观察改良根治术和改良根治术后即刻背阔肌皮瓣乳房重建治疗乳腺癌患者的围手术期情况和生活质量。方法前瞻性研究,选择2016年1月至2018年9月柳州市人民医院收治的女性乳腺癌患者86例,采用随机数字表法将患者分为对照组和观察组,每组各43例。对照组患者给予传统改良根治术治疗,观察组患者给予改良根治术后即刻背阔肌皮瓣乳房重建。比较两组患者的围手术期情况、生活质量、乳房满意度、应激反应和焦虑抑郁情况等。结果观察组患者的术后引流时间为(7.42±2.49)d,术后开始辅助化疗时间为(8.79±2.71)d,术后并发症发生率为18.60%,对照组分别为(7.35±2.41)d、(8.62±2.64)d和13.95%,差异无统计学意义(P>0.05)。观察组患者的功能状况、生理状况、情感状况、社会及家庭状况和附加关注状况评分分别为(19.37±3.62)分、(15.29±3.41)分、(18.25±3.62)分、(21.58±4.03)分和(26.83±4.82)分,均高于对照组,差异具有统计学意义(P<0.05)。观察组患者满意34例(79.07%),一般6例(13.95%),总满意40例(93.02%),对照组总满意率仅为65.12%,差异具有统计学意义(P<0.05)。观察组患者的皮质醇(Cor)水平、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评分分别为(257.26±27.94)ng/mL、(10.14±2.07)分和(10.86±2.47)分,低于对照组,超氧化物歧化酶(SOD)水平为(68.25±7.19)U/mL,高于对照组,差异具有统计学意义(P<0.05)。结论乳腺癌改良根治术后即刻背阔肌皮瓣乳房重建与传统改良根治术相比,具有相似的疗效和安全性,但能明显改善患者术后乳房的外形美观度,从而提高患者的乳房满意度和术后生活质量,减轻应激反应和焦虑抑郁情绪,值得在临床推广应用。

Objective To compare the perioperative situation and quality of life of patients with breast cancer treated by modified radical mastectomy and immediate latissimus dorsi flap breast reconstruction after modified radical mastectomy.Methods This was a prospective study,86 patients with breast cancer who were treated in Liuzhou People's Hospital from January 2016 to September 2018 were selected.The patients were divided into control group and observation group by random number table method,43 cases in each group.The control group was treated with traditional modified radical mastectomy,while the observation group was treated with modified latissimus dorsi myocutaneous flap for breast reconstruction immediately after radical mastectomy.The perioperative condition,quality of life,breast satisfaction,stress response,anxiety and aepression were compared between the two groups.Results The postoperative drainage time of the patients in the observation group was(7.42±2.49)d,the time to start adjuvant chemotherapy after surgery was(8.79±2.71)d,and the incidence of postoperative complications was 18.60%,compared with(7.35±2.41)d,(8.62±2.64)d and 13.95%in the control group respectively,with no significant difference(P>0.05).The scores of functional status,physiological status,emotional status,social and family status and additional attention status of the patients in the observation group were(19.37±3.62)scores,(15.29±3.41)scores,(18.25±3.62)scores,(21.58±4.03)scores and(26.83±4.82)scores respectively,which were higher than those in the control group,the difference was statistically significant(P<0.05).There were 34 patients(79.07%)in the observation group,6 patients(13.95%)in general,and 40 patients(93.02%)in total,the total satisfaction rate in the control group was only 65.12%,the difference was statistically significant(P<0.05).The cortisol(Cor)level,Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD)scores of the patients in the observation group were(257.26±27.94)ng/mL,(10.14±2.07)scores and(10.86±2.47)scores respectively,which were lower than those in the control group,while the superoxide dismutase(SOD)level was(68.25±7.19)U/mL,which was higher than the control group,the difference was statistically significant(P<0.05).Conclusion Immediate latissimus dorsi flap breast reconstruction after modified radical mastectomy has comparable efficacy and safety compared with traditional modified radical mastectomy,but it can significantly improve the appearance and beauty of the patients'breasts,thus improving the patients'breast satisfaction and quality of life,reducing stress response and anxiety and depression,which is worthy of clinical application.