双侧乳房重建118例单中心回顾性研究

118 cases of bilateral breast reconstruction based on a single-center retrospective analysis

目的探讨双侧乳房重建手术的开展情况和影响因素。方法对复旦大学附属肿瘤医院2000年1月至2019年12月间接受双侧乳房重建手术的病人资料进行回顾性分析,描述病人人口学、临床病理特征、双侧乳房重建手术规模、手术时机和方式,探讨双侧乳房重建手术方式选择过程中的影响因素。采用t检验、χ2检验以及Fisher检验进行显著性检验;利用单因素及多因素回归分析,对上述影响因素进行统计学检验。结果2913例病人接受乳腺癌全乳切除术后乳房重建,其中双侧乳房重建病人共118例,占重建总数的4.05%。双侧乳腺癌病人82例,对侧乳房预防性切除的单侧乳腺癌病人31例,15例病人为一侧或双侧延期乳房重建。双侧即刻重建者103例,占87.3%,10例病人行单侧乳房延期重建,5例行双乳延期重建。双侧植入物重建97例(82.2%),一侧植入物重建另一侧自体重建共9例(7.6%),其余12例(10.2%)为双侧自体重建。乳房切除动机(治疗性/预防性)、双侧乳房切除时机(同时性/异时性)以及辅助放疗与双侧乳房重建方式选择相关。多因素分析发现,异时性双乳切除病人与术后需要行辅助放疗的病人更倾向于选择一侧或双侧自体重建。同时行双乳切除接受即刻植入物重建时,扩张器-假体两步法占比更高,达76.5%。和单侧乳房重建比较,双侧乳房重建术后非计划再次手术和重建失败的比例差异无统计学意义。结论当前国内双侧乳房重建的占比虽然较低,但是面临潜在的增长趋势。乳腺癌多学科团队应制订合理的手术适应证,结合病人意愿,选择恰当的手术时机和方式,从而使临床决策更为规范。

Objective MethodsThe patients who underwent bilateral breast reconstruction surgery in the Affiliated Cancer Hospital of Fudan University from January 2000 to December 2019 were analyzed retrospectively.Patients’demographic and clinicopathological characteristics,scale,timing and modality of bilateral breast reconstructive surgery were described.Related factors in the selection of bilateral breast reconstructive surgery were discussed.Data were analyzed using t-test,χ;,and Fisher test for significance.Statistical significance of the above factors,and tested by univariate and multivariate regression analysis.Results2913 patients received breast reconstruction after mastectomy,of which 118 cases had bilateral breast reconstruction,accounting for 4.05%of the total reconstruction.There were 82 cases of bilateral breast cancer,31 cases of unilateral breast cancer with contralateral prophylactic mastectomy,and 15 cases with unilateral or bilateral delayed breast reconstruction.103 patients(87.3%)underwent bilateral immediate breast reconstruction.10 patients underwent unilaterally delayed reconstruction and 5 patients with bilateral delayed reconstruction.97 cases(82.2%)received bilateral implant-based reconstruction(IBR),9 cases(7.6%)with IBR on one side and autologous breast reconstruction(ABR)for another breast.The other 12 cases underwent bilateral ABR(10.2%).The motivation of mastectomy(therapeutic or prophylactic),the timing of bilateral mastecto-my(simultaneous/isochronous)and adjuvant radio-therapy were related to the choice of bilateral breastreconstruction.Multivariate analysis showed that pa-tients with isochronous bilateral mastectomy and pa-tients who needed adjuvant radiotherapy were more likely to choose ABR.When simultaneous bilateral mastectomy and immediate IBR were performed,the proportion of ex-pander-implant two-stage method was higher,up to 76.5%.Compared with unilateral breast reconstruction,there was nosignificant difference in the proportion of unplanned reoperation and reconstruction failure after bilateral breast recon-struction.ConclusionAt present,although the proportion of bilateral breast reconstruction in China is low,it faces apotential growth.The multidisciplinary team of breast cancer should formulate reasonable surgical indications and choosethe right timing and technique of breast reconstruction combined with patients’wishes,so as to make clinical decisionsmore standardized.