两种腹部皮瓣乳房再造术后腹部功能和满意度评价

Abdominal function and patient-reported satisfaction after two kinds of abdominal flap breast reconstruction

目的:研究2种腹部皮瓣乳房再造术对患者腹部功能和美学的影响。方法:回顾性分析2013年7月至2018年6月在华中科技大学同济医学院附属协和医院完成的乳房再造病例的临床资料。根据纳入标准和排除标准,将采用腹壁下动脉穿支皮瓣(DIEP)或保留肌肉的带蒂横行腹直肌肌皮瓣(TRAM)行乳房再造的患者纳入研究。设计调查表评价患者术前、术后3个月和术后1年的腹壁强度,以及术后1年腹部外观;应用BREAST-Q乳房再造腹部健康模块评估患者术前、术后3个月和术后1年对腹部的满意度。应用SPSS 21.0统计软件对数据进行处理分析。2组之间比较采用独立样本t检验;单组术前、术后比较,采用配对t检验。P<0.05为差异具有统计学意义。结果:共纳入32例患者,根据手术方式分为2组,其中DIEP乳房再造组17例,年龄(43.6±9.2)岁,TRAM乳房再造组15例,年龄(41±10.1)岁。术后随访12~73个月,平均41.5个月。术前DIEP组和TRAM组腹壁强度评分分别为(4.71±0.47)分和(4.60±0.50)分,两者比较差异无统计学意义(P>0.05);术后3个月,DIEP组患者的腹壁强度评分为(2.65±0.86)分,高于TRAM组的(1.93±0.70)分(P<0.05),2组评分与术前相比差异有统计学意义(P<0.01);术后1年,DIEP组腹壁强度评分为(4.65±0.49)分,显著高于TRAM组的(4.07±0.88)分(P<0.05),DIEP组评分与术前相比差异无统计学意义(P>0.05),TRAM组评分与术前相比差异有统计学意义(P<0.05)。术后1年,2组腹部外观评分比较,差异无统计学意义(P>0.05)。术前DIEP组和TRAM组腹部满意度评分分别为(86.53±5.68)分和(85.87±7.31)分,两者比较差异无统计学意义(P>0.05);术后3个月,DIEP组患者腹部满意度评分为(76.41±7.74)分,高于TRAM组的(68.00±9.08)分(P<0.01),2组评分分别与术前比较,差异均具有统计学意义(P<0.01);术后1年,DIEP组腹部满意度评分为(85.00±5.32)分,与TRAM组的(82.93±6.12)分相比,差异无统计学意义(P>0.05),DIEP组评分与术前比较,差异无统计学意义(P>0.05),TRAM组与术前比较,差异有统计学意义(P<0.05)。结论:2种腹部皮瓣乳房再造患者均能获得较好的腹部外观,DIEP乳房再造患者术后1年腹部功能和腹部满意度能恢复至接近术前水平,而TRAM乳房再造患者仍低于术前水平,更长期的影响需要做进一步研究。

ObjectiveTo investigate the abdominal function and aesthetics outcomes of patients with abdominally based breast reconstruction.MethodsIn this research, we retrospectively analyzed the cases of breast reconstruction in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from July 2013 to June 2018. In accordance with the inclusion and exclusion criteria, patients undergoing breast reconstruction by deep inferior epigastric perforator flap (DIEP) or muscle-sparing transverse rectus abdominis myocutaneous flap (TRAM) were included in the study. A questionnaire was designed to evaluate the patient’s abdominal strength, and the BREAST-Q breast reconstruction abdominal health module was used to assess the patient’s satisfaction degree with the abdomen. SPSS 21.0 statistical software was used to analyze the data. The independent-samples t test is used for comparison between the two groups;the matched-samples t test is used for the preoperative and postoperative comparison of a single group. P<0.05 indicates that the difference is statistically significant.ResultsA total of 32 patients were enrolled, including 17 cases of DIEP breast reconstruction, aged 43.6±9.2 years old, and 15 cases of TRAM breast reconstruction, aged 41.0±10.1 years old. The postoperative follow-up period ranged from 12 to 73 months, with an average of 41.5 months. Preoperative abdominal wall strength scores in the DIEP group and the TRAM group were 4.71±0.47 and 4.60±0.50 , respectively, and there were on significant difference between two groups. Three months after operation, the abdominal wall strength of the DIEP group scored 2.65±0.86, which was higher than the score in the TRAM group(1.93±0.70) (P<0.05). The scores of the two groups were significantly different from those before operation (P<0.01). One year after the operation, the abdominal wall strength of DIEP group scored 4.65±0.49, which was significantly higher than the score in TRAM group (4.07±0.88)(P<0.05). There was no significant difference between the scores of DIEP group and those before operation (P>0.05), however, the scores of TRAM group were significantly different from those before surgery (P<0.05). One year after operation, the appearance of the abdomen was not significantly different between the preoperative and postoperative score in both two groups (P>0.05). Preoperative abdominal satisfaction scores of the DIEP group and the TRAM group were 86.53±5.68 and 85.87±7.31, respectively, and there was no significant difference between two groups (P>0.05). Three months after the operation, the abdominal satisfaction score of the DIEP group was 76.41±7.74, which was higher than the score in the TRAM group(68.00±9.08) (P<0.01). The scores of the two groups were compared with those before surgery, and the differences were statistically significant (P<0.01). One year after the operation, the abdominal satisfaction score was 85.00±5.32 in the DIEP group and 82.93±6.12 in the TRAM group, showing no statistical significance between two groups (P>0.05). There was no significant difference between the scores of DIEP group and those before operation (P>0.05), however, the scores of TRAM group were significantly different from those before surgery (P<0.05).ConclusionsThe study demonstrates that both two kinds of abdominal flaps can obtain a better abdominal appearance. The long-term abdominal function and abdominal satisfaction of patients undergoing breast reconstruction with DIEP flaps can return to the baseline levels, however, that of TRAM flaps can not return to the baseline levels. Further research is needed for the longer term results.