术后即刻双平面乳房重建在早期乳腺癌患者中的应用效果

Effectiveness of immediate biplane breast reconstruction in early breast cancer surgery

目的探讨双平面乳房重建在早期乳腺癌术后即刻假体乳房重建中的应用效果。方法回顾性分析2013年6月至2018年6月在扬州大学附属医院甲乳外科接受保留乳头-乳晕复合体或保留皮肤的乳房切除术并进行即刻乳房重建(immediate breast reconstruction,IBR)的60例早期乳腺癌患者的临床资料,其中采用双平面乳房重建(以胸大肌-胸外侧融合筋膜系统覆盖假体)进行IBR的患者作为观察组(30例,33侧乳房),采用部分背阔肌覆盖假体进行IBR的患者作为对照组(30例,33侧乳房)。比较两组患者的手术相关指标,二次手术和假体丢失情况,局部复发率、远处转移率和患者满意度,以及术后并发症发生情况。结果观察组的假体体积大于对照组,手术时间及住院时间短于对照组,术中失血量及术区引流量少于对照组,拔管时间长于对照组,差异均有显著性(P<0.05)。观察组的二次手术率(6.06%)、假体丢失率(9.09%)、局部复发率(10.00%)、远处转移率(6.67%)与对照组(分别为9.09%、6.06%、6.67%、3.33%)比较差异均无显著性(P>0.05),而患者满意度(96.67%)高于对照组(80.00%),术后并发症发生率(12.12%)低于对照组(34.38%),差异有显著性(P<0.05)。结论双平面乳房重建在早期乳腺癌IBR中具有较好的临床效果,安全性高,术后并发症少,患者满意度高,值得临床应用。

Objective To investigate the effectiveness of biplane breast reconstruction in immediate postoperative prosthetic breast reconstruction after early breast cancer.Method Retrospective analysis of 60 patients with early-stage breast cancer who underwent mastectomy with preserved nipple-areola complex or preserved skin and immediate breast reconstruction(IBR)from June 2013 to June 2018 in the Department of A Breast of the Affiliated Hospital of Yangzhou University,in which patients who underwent IBR with biplane breast reconstruction(pectoralis major muscle-external thoracic fusion fascial system covered prosthesis)were used as the observation group(30 cases,33)The patients who underwent IBR with a partial latissimus dorsi muscle-covered prosthesis were the control group(30 patients,33 breasts).The surgery-related indexes,secondary surgery and prosthesis loss,local recurrence rate,distant metastasis rate and patient satisfaction,as well as the occurrence of postoperative complications were compared between the two groups.Result The observation group had a larger prosthesis volume than the control group,shorter operative time and hospital stay,less intraoperative blood loss and intraoperative area drainage than the control group,and longer extubation time than the control group,all with significant differences(P<0.05).There were no significant differences(P>0.05)in the rates of secondary surgery(6.06%),prosthesis loss(9.09%),local recurrence(10.00%),and distant metastasis(6.67%)in the observation group compared with the control group(9.09%,6.06%,6.67%,and 3.33%,respectively),while patient satisfaction(96.67%)was higher than that of the control group(80.00%)and the incidence of postoperative complications(12.12%)was lower than that of the control group(34.38%),with a significant difference(P<0.05).Conclusion Biplane breast reconstruction has good clinical results in early stage breast cancer IBR with high safety,few complications and high patient satisfaction.