改良保乳术结合即刻乳房再造术对乳腺癌患者术后疼痛程度及美学效果的影响

Effect of Modified Breast-conserving Surgery Combined with Immediate Breast Reconstruction on Postoperative Pain and Cosmetic Effect in Breast Cancer Patients

目的:探讨改良保乳术即刻乳房整形再造术在乳腺癌患者中的疗效,并分析对患者疼痛程度及美学效果影响程度。方法:选取2015年1月-2016年2月在笔者医院治疗的乳腺癌患者95例为研究对象,采用信封法随机分为观察组(n=47)和对照组(n=48),对照组仅行改良保乳术,观察组在对照组基础上给予即时乳房整形再造术。比较两组患者手术时间、术中出血量、清扫淋巴结数量、住院时间、术后乳房美学效果、术后瘢痕评分(VSS)和视觉模拟评分(VAS)、手术前后生活质量、手术前后VEGF、EGF水平变化情况、预后情况的影响。结果:观察组手术时间明显长于对照组,差异具有统计学意义(P<0.05),但两组住院时间、术中出血量、清扫淋巴结数量比较,差异无统计学意义(P>0.05)。观察组美学效果明显优于对照组(P<0.05)。术后观察组VAS评分及VSS评分均明显高于对照组(P<0.05)。术后情感状况、生理状况、社会及家庭状况、功能状况、附加关注状况评分均显著升高,观察组术后以上指标明显高于对照组(P<0.05)。术后表皮细胞生长因子(EGF)、血管内皮细胞生长因子(VEGF)均显著降低,且观察组术后以上指标均明显低于对照组(P<0.05)。观察组5年无复发生存率(RFS)明显高于对照组(P<0.05),但两组5年总生存时间(OS)比较无显著差异(P>0.05)。结论:乳腺癌改良根治术后即时乳房整形再造术患者乳房美学效果明显优于未行再造术者,但乳房再造术会增加患者疼痛程度,促进瘢痕发展,临床需根据患者实际情况给予针对性治疗手段。

Objective The aim of this study was to investigate the curative effect of modified breast-conserving surgery with immediate breast reconstruction on breast cancer patients,and the influence on pain degree and cosmetic effect.Methods A total of 95 breast cancer patients who were treated in the author’s hospital from January 2015 to February 2016 were selected as the research objects and randomly divided into the observation group(n=47)and the control group(n=48)by the envelope method.Modified breast conserving surgery,the observation group was given immediate breast plastic reconstruction on the basis of the control group.The operation time,intraoperative blood loss,number of dissected lymph nodes,hospital stay,postoperative breast cosmetic effect,postoperative scar score(VSS)and visual analogue scale(VAS),quality of life before and after surgery,VEGF,EGF before and after surgery were compared between the two groups Level changes,the impact of prognosis.Results The operation time of the observation group was significantly longer than that of the control group,and the difference was statistically significant(P<0.05).there was no significant difference in hospital stay,intraoperative blood loss,and number of dissected lymph nodes between the two groups(P>0.05).The cosmetic effect of the observation group was significantly better than that of the control group P<0.05).The VAS score and VSS score of the observation group were significantly higher than those of the control group after operation(P<0.05).The scores of emotional status,physiological status,social and family status,functional status,and additional attention status after operation were significantly increased,and the above indexes in the observation group were significantly higher than those in the control group after operation(P<0.05).Postoperative epidermal growth factor(EGF)and vascular endothelial growth factor(VEGF)were significantly decreased,and the above indexes in the observation group were significantly lower than those in the control group after surgery(P<0.05).The 5-year recurrence-free survival(RFS)in the observation group was significantly higher than that in the control group(P<0.05),but there was no significant difference in the 5-year overall survival(OS)between the two groups(P>0.05).Conclusion Patients undergoing breast plastic reconstruction immediately after modified radical mastectomy can obtain better cosmetic results than those not undergoing reconstruction.However,breast reconstruction will increase the patients’pain degree,and promote the development of scar.In clinical practice,targeted treatment should be chosen based on the patient’s actual condition.