可调式外扩张器辅助自体脂肪移植重建乳腺癌术后乳房的效果

Application of adjustable external volume expansion assisted autologous fat grafting in breast reconstruction after breast cancer surgery

目的比较乳腺癌术后用可调式外扩张器(EVE)辅助自体脂肪移植和单纯自体脂肪移植重建乳房的效果。方法2016年12月至2020年1月,南方医科大学南方医院整形外科纳入乳腺癌术后重建乳房女性患者17例,年龄23〜54岁,平均44.8岁。试验组10例术前4周每天佩戴EVE 10 h.负压值-60 mmHg;术后第2周继续每天佩戴EVE 10 h,初始负压值-40 mmHg,1周后调整至_20 mmHg,术后佩戴4周。试验组和对照组(7例)均选择经典Coleman方法行自体脂肪移植乳房重建术。结果手术次数:试验组(3.0±0.8)次与对照组(3.9±1.2)次比较,差异有统计学意义(t=2.193,P<0.05)。单侧乳房单次脂肪注射量:试验组(228.60±15.34)ml与对照组(198.20±12.01)ml比较,差异有统计学意义(t=4.861,P<0.01)。单侧单次脂肪体积保存率:试验组(31.6±5.8)%与对照组(25.8±6.2)%比较,差异有统计学意义(t=2.226,P<0.05)。术后并发症:试验组为3/10例,对照组为3/7例。结论乳腺癌术后选择自体脂肪移植重建乳房患者辅助EVE减少手术次数,提高单次乳房可注射脂肪量和术后脂肪保存率,降低术后并发症,是一种行之有效的手术方式。

Objective To compare the difference and effect of fat grafting assisted by adjustable external volume expansion(EVE)and fat grafting only in female patients who chose autologous fat grafting for breast reconstruction after a breast cancer operation.Methods A retrospective analysis was carried out in 17 patients in the past four years.The patients in the experimental group wore EVE 10 hours daily for four weeks before surgery,and the negative preSvSure value was-60 mmHg.From the second week after the operation,they continued to wear EVE 10 hours every day,and the initial negative pressure value was-40 mmHg.After one week,the negative pressure was adjusted to-20 mmHg,and the EVE was worn for four weeks after surgery.Both the experimental group and the control group chose clasvsical Coleman fat for breast reconstruction.Results The number of operations in the experimental and control groups was 3.0±0.8 and 3.9dz 1.2,respectively(t=2.193;P<0.05).The single fat injection volume of the experimental group and the control group was(228.60±15.34)ml and(198.20±12.01)ml,respectively(t=4.861;P<0.01).The single fat volume preservation rate of the experimental group and the control group was(31.6±5.8)%and(25.8±6.2)%,respectively(t=2.226;P<0.05).For postoperative complications,there were 3 cases in the experimental group(10 cases in total)and 3 cases in the control group(7 cases in total).Conclusions For breast cancer patients who choose autologous fat grafting for breast reconstruction,wearing EVE can reduce the number of operations,improve the single fat injection volume and postoperative fat preservation rate,and reduce postoperative complications.