带蒂大网膜联合硅胶假体乳房重建术后放射治疗的动物实验研究

Radiotherapy following breast reconstruction using a pedicled omental flap combined with a silicone implant in dogss

目的研究放射治疗对实验犬带蒂大网膜联合硅胶假体乳房重建术的影响。方法选择健康本地犬20只。每只实验犬选择前腹乳房进行2种乳房重建手术,左乳行带蒂大网膜联合硅胶假体乳房重建(网膜组),右乳行单纯硅胶假体乳房重建术(假体组)。2组于术后4周均接受同等剂量放射治疗,放射治疗后8个月取出网膜、假体及包膜。术后假体包膜挛缩发生率的组间比较采用配对χ^(2)检验(McNemar法),包膜厚度和包膜微血管密度的组间比较采用配对样本1检验。结果2组放射治疗后假体包膜挛缩率分别为25.0%(5/20)与5.0%(1/20),组间比较,差异无统计学意义(χ^(2)=2.670,P=0.219)。假体组包膜厚度高于网膜组[(1.4±0.2)mm比(0.8±0.1)mm,1=4.173,P=0.001]。网膜组微血管密度高于假体组[(44.3±5.1)条/高倍视野比(28.4±2.8)条/高倍视野,t=5.202,P<0.001]。结论放射治疗对实验犬带蒂大网膜联合硅胶假体乳房重建术的影响较小,大网膜对硅胶假体具有保护作用。

Objective To investigate the effect of radiotherapy on breast reconstruction using the pedicled omental flap combined with a silicone implant in experimental dogs.Methods Twenty healthy local dogs were used for the experiment.Each experimental dog underwent 2 types of breast reconstruction in anterior ventral breasts.They underwent breast reconstruction using a pedicled omental flap and a silicone implant in the left breast(the omental flap group),and prosthetic breast reconstruction only with a silicone implant in the right breast(the implant group).Four weeks after surgery,radiotherapy of the same dose was given for both breasts.Eight months after radiotherapy,the omental flap,implants and capsules were removed from the dogs.The rate of capsular contracture was compared between groups by paired χ^(2) test(McNemar test).The thickness of capsule and microvascular density were compared between groups by paired-samples t test.Results The capsular contracture rate in the implant group and the omental flap group was 25.0%(5/20)and 5.0%(1/20),respectively,indicating no significant diference(χ^(2)=2.670,P=0.219).Thickness of the capsule in the implant group was significantly higher than that in the omental flap group[(1.4±0.2)mm vs(0.8±0.1)mm,t=4.173,P=0.001].Microvascular density in the omental flap group was significantly higher than that in the implant group(vessels in each high power field:44.3±5.1 vs 28.4±2.8,t=5.202,P<0.001).Conclusion Radiotherapy shows little effect on breast reconstruction with a pedicled omental flap and a silicone implant in experimental dogs and the omentum has a protective effect on the silicone implant.