背阔肌肌皮瓣联合自体脂肪组织即刻乳房重建在乳腺癌术后的应用价值研究

Application value of latissimus dorsi myocutaneous flap combined with autologous adipose tissue for immediate breast reconstruction after breast cancer surgery

目的探讨背阔肌肌皮瓣联合自体脂肪组织即刻乳房重建在乳腺癌术后的应用价值。方法回顾性分析2014年1月至2019年1月于深圳市中医院行乳腺癌改良根治术治疗的86例乳腺癌患者的临床资料,根据乳房重建方式的不同将其分为假体组(40例)和自体脂肪组(46例)。两组患者均行常规乳腺癌改良根治术,假体组患者在术后行背阔肌肌皮瓣联合假体置入即刻乳房重建,自体脂肪组患者在术后行背阔肌肌皮瓣联合自体脂肪组织置入即刻乳房重建。比较两组患者术后临床情况、癌症自我管理效能感量表(strategies used by people to promote health,SUPPH)、生活质量核心量表(quality of life questionnaire-core 30,QLQ-30)、生活质量满意度、美观效果和并发症发生情况。结果两组患者术后引流时间、住院天数、开始辅助治疗时间比较差异均无统计学意义(均P>0.05)。两组患者术后SUPPH、QLQ-30评分均显著高于本组术前(均P<0.05),自体脂肪组患者术后SUPPH、QLQ-30评分均显著高于假体组(均P<0.05)。自体脂肪组患者术后焦虑占比和术后总并发症发生率均显著低于假体组(均P<0.05),对体型、社交满意的占比和美学效果优良率均显著高于假体组(均P<0.05)。结论乳腺癌改良根治术后行背阔肌肌皮瓣联合自体脂肪组织即刻乳房重建安全性较高,美观效果较好,可显著提高患者生活质量。

Objective To study the application value of latissimus dorsi myocutaneous flap(LDMF)combined with autologous adipose tissue for immediate breast reconstruction after breast cancer surgery.Method Clinical data of 86 breast cancer patients who received modified radical mastectomy for breast cancer in Shenzhen Hospital of Traditional Chinese Medicine from January 2014 to January 2019 were retrospectively analyzed.According to the different methods of breast reconstruction,they were divided into prosthesis group(40 cases)and autologous fat group(46 cases).Both groups of patients underwent conventional modified radical mastectomy.Patients in prosthesis group received LDMF combined with implantation of the prosthesis for immediate breast reconstruction,and patients in autologous fat group received LDMF combined with autologous adipose tissue implantation for immediate breast reconstruction.The postoperative clinical situation,strategies used by people to promote health(SUPPH),quality of life questionnaire-core 30(QLQ-30),quality of life satisfaction,aesthetic effect and incidence of complications were compared between the two groups.Result There were no significant differences in the time of drainage,hospital day and the beginning of adjuvant therapy between the two groups(all P>0.05).Postoperative SUPPH and QLQ-30 scores in two groups were significantly higher than those in the group before surgery(all P<0.05),and SUPPH and QLQ-30 scores in autologous fat group were significantly higher than those in prosthesis group(all P<0.05).The proportion of postoperative anxiety and the incidence of postopertive complications in autologous fat group were significantly lower than those in prosthesis group(P<0.05),and proportion of body shape and social satisfaction were significantly higher than those in prosthesis group(all P<0.05).Conclusion Immediate breast reconstruction with LDMF combined with autologous adipose tissue after modified radical mastectomy is safe and aesthetic effect.It can significantly improve the quality of life of patients.