全乳切除术后延迟与即刻重建术在中青年乳腺癌患者中的应用效果

Application effect of delayed and immediate reconstruction after radical mastectomy in young and middle-aged breast cancer patients

目的探讨全乳切除术后延迟或即刻重建术在中青年乳腺癌患者中的应用效果。方法根据治疗方案将104例中青年乳腺癌患者分为即刻组(n=60)和延迟组(n=44),即刻组患者乳腺癌根治术后即刻行乳房重建术,延迟组患者乳腺癌根治术后6~12个月行乳房重建术。比较两组乳房外观、血清肿瘤标志物[糖类抗原15-3(CA15-3)、癌胚抗原(CEA)]水平、负性情绪[焦虑自评量表(SAS)和抑郁自评量表(SDS)]、生活质量[乳腺癌患者生存质量测定量表(FACT-B)]和复发转移情况。结果两组患者乳房外观、复发转移率比较均无明显差异(P>0.05)。治疗后,两组患者血清CA15-3、CEA水平及SAS、SDS评分均低于本组治疗前(P<0.05),且即刻组患者SAS、SDS评分均低于延迟组(P<0.05)。治疗后,两组患者FACT-B量表各维度评分和总分均高于本组治疗前(P<0.05)。结论全乳切除术后即刻乳房重建可减轻乳腺癌患者的负性情绪,但乳房外观、远期生活质量与延迟重建术无明显差异。

Objective To investigate the effect of delayed or immediate reconstruction after total mastectomy in young and middle-aged breast cancer patients.Method According to the treatment plan,104 young and middle-aged breast cancer patients were divided into immediate group(n=60)and delayed group(n=44).Patients in the immediate group underwent breast reconstruction immediately after radical mastectomy,while those in the delayed group underwent breast reconstruction 6 to 12 months after radical mastectomy.The breast appearance,serum tumor marker[carbohydrate antigen 15-3(CA15-3),carcinoembryonic antigen(CEA)]levels,negative emotions[self-rating anxiety scale(SAS),selfrating depression scale(SDS)],quality of life[functional assessment of cancer therapy-breast(FACT-B)],and recurrence and metastasis were compared between the two groups.Result There were no significant differences in breast appearance and recurrence and metastasis rates between the two groups(P>0.05).After treatment,the serum CA15-3 and CEA levels of the two groups were lower than those before treatment(P<0.05),and the SAS and SDS scores were lower than those before treatment(P<0.05),and the SAS and SDS scores of the immediate group were lower than those of the delayed group(P<0.05).After treatment,the scores of each dimension and total score of FACT-B in the two groups were higher than those before treatment(P<0.05).Conclusion Immediate reconstruction after total mastectomy can reduce the negative mood,but there are no significant differences for the breast appearance and long term quality of life with delayed reconstruction.