融合筋膜联合植入物即刻乳房重建的可行性研究

Feasibility study of immediate breast reconstruction with fusion fascia combined with implants

目的探讨融合筋膜法进行植入物即刻乳房重建的肿瘤学及外科学安全性。方法回顾性分析2014—2017年天津医科大学肿瘤医院343例植入物乳房即刻重建患者的临床资料,比较融合筋膜与其他方法乳房重建患者的5年无局部区域复发生存率、5年无病生存率和5年总生存率,分析不同植入物患者组间发生植入物取出的并发症发生率。结果343例乳房重建患者中,融合筋膜组(筋膜组)95例,非筋膜组248例(牛心包补片组25例,肌瓣组223例)。中位随访49个月,筋膜组与非筋膜组患者的5年无局部区域复发生存率(分别为90.1%和94.9%)、5年无病生存率(分别为89.2%和87.6%)和5年总生存率(分别为95.2%和95.1%)差异均无统计学意义(均P>0.05)。补片组植入物取出的并发症发生率为24.0%(6/25),筋膜组与肌瓣组分别为2.1%(2/95)和2.2%(5/223)。结论融合筋膜联合植入物即刻乳房重建是安全可行的,较肌肉瓣损伤小,与补片比较更经济且并发症少。

Objective To investigate the oncologic and surgical safety of the fused fascia method for immediate breast reconstruction with implants.Methods The clinical data of 343 patients with immediate breast reconstruction with implants in Tianjin Medical University Cancer Hospital from 2014-2017 were retrospectively analyzed to compare the 5-year local recurrence-free survival,5-year disease-free survival and 5-year overall survival of patients with breast reconstruction by fusion fascia and other methods,and to analyze the complication incidences of implant removal between different implant groups.Results Of the 343 patients with breast reconstruction,95 were in the fused fascia group(fascia group)and 248 were in the non-fascia group(25 in the bovine pericardial patch group and 223 in the muscle flap group).At a median follow-up of 49 months,the differences in 5-year local recurrence-free survival(90.1% and 94.9%,respectively),5-year disease-free survival(89.2% and 87.6%,respectively),and 5-year overall survival(95.2% and 95.1%,respectively)between patients in the fascial and non-fascial groups were not statistically significant(P>0.05).The complication incidence of implant removal was 24.0%(6/25)in the patch group and 2.1%(2/95)and 2.2%(5/223)in the fascia and muscle flap groups,respectively.Conclusion Immediate breast reconstruction with fused fascial combined with implant is safe and feasible,less invasive than muscle flaps,more economical and with fewer complications than patches.