保留乳头乳晕复合体乳房切除术中三种乳房重建术的临床效果对比

Comparison of clinical effects of three kinds of breast reconstruction in nipple-preserving areola complex mastectomy

目的探讨三种即刻乳房重建术在保留乳头乳晕复合体乳房切除术(NSM)的临床疗效。方法回顾性分析2017年1月至2019年12月乳房重建的131例NSM患者临床资料,根据乳房重建方式不同分为三组,假体组(n=56,假体植入),自体组(n=43,背阔肌皮瓣植入),联合组(n=32,背阔肌联合假体植入)。采用SPSS 21.00软件进行数据分析,围术期指标等计量资料采用(x±s)表示,多组间比较采用单因素方差分析;术后并发症等计数资料采用χ^(2)检验,等级计数资料采用秩和检验;Kaplan-Meier法分析预后总生存率(OS)和无病生存率(DFS)。P<0.05为差异有统计学意义。结果三组术中出血量、引流总流量、住院时间、术后并发症总发生率比较差异均无统计学意义(P>0.05);自体组和联合组总优良率均显著高于假体组(P<0.05),但这两组总优良率差异无统计学意义(P>0.05);三组患者DFS、OS比较差异无统计学意义(P>0.05)。结论NSM的三种即刻乳房重建术均安全有效,其中采用背阔肌皮瓣或其联合假体进行乳房重建术的美容效果更佳,临床可根据患者个人意愿及生理条件选择合适的乳房重建术式。

Objective To investigate the clinical effect of three types of immediate breast reconstruction in nipple and areola complex mastectomy(NSM).Methods The clinical data of 131 NSM patients undergoing breast reconstruction from January 2017 to December 2019 were retrospectively analyzed.According to different breast reconstruction methods,the patients were divided into three groups:prosthesis group(n=56,prosthesis implantation),autogenous group(n=43,latissimus dorsi flap implantation),and combined group(n=32,latissimus dorsi combined prosthesis implantation).Using SPSS 21.00 software for data analysis,perioperative indicators such as measurement data using said,compared using analysis of variance between groups;Postoperative complication rate and other data were counted byχ^(2) test.The beauty effect was evaluated by rank sum test.Overall survival(OS)and disease-free survival(DFS)were analyzed by Kaplan-Meier method.P<0.05 was statistically significant.Results There were no statistically significant differences in the perioperative indexes such as intraoperative blood loss and total drainage flow among the three groups(P>0.05);there was no statistically significant difference in the total incidence of complications among the three groups(P>0.05);autologous group and combined.The overall excellent and good rate of the group was significantly higher than that of the prosthetic group,the difference was statistically significant(P<0.05),but the total excellent and good rate of the autologous group and the combined group was not statistically different(P>0.05);There was no significant difference in DFS and OS among the three groups(P>0.05).Conclusion Three kinds of immediate breast reconstruction with NSM are safe and effective.The latissimus dorsi flap or its combined prosthesis has better cosmetic effect.The appropriate breast reconstruction operation can be selected according to the individual wishes and physiological conditions of patients.