乳腺癌超象限切除术联合带蒂背阔肌皮瓣转移乳房重建术对乳腺癌美容及预后的影响观察

Observation on the effect of super-quadrant breast-conserving resection combined with pedicled latissimus dorsi musculocutaneous flap for breast reconstruction on the cosmetic and prognosis of breast cancer

目的 探讨乳腺癌超象限切除术联合带蒂背阔肌皮瓣转移乳房重建术对乳腺癌美容及预后的影响。方法 选取50例行乳腺癌超象限切除术联合带蒂背阔肌皮瓣转移乳房重建术的乳腺癌患者作为观察组,另选取同一时间段50例行传统保乳手术的乳腺癌患者作为对照组。比较两组患者术后并发症发生率、乳房的美容效果、预后情况以及手术前后自尊、自我形象水平。结果 观察组术后乳房的美容效果明显优于对照组,差异有统计学意义(P<0.05)。观察组与对照组术后感染和皮瓣坏死、切口愈合不良、皮下积液的发生率比较,差异无统计学意义(P>0.05)。两组患者远处转移、复发转移及生存率比较,差异无统计学意义(P>0.05)。手术前,两组患者乳腺癌自我形象量表(BIBCQ)、自尊量表(SES)评分比较,差异无统计学意义(P>0.05);手术后,观察组BIBCQ评分(98.56±8.88)分明显低于对照组的(121.31±9.18)分, SES评分(30.85±3.86)分明显高于对照组的(24.65±3.15)分,差异有统计学意义(P<0.05)。结论 乳腺癌患者采用乳腺癌超象限切除术联合带蒂背阔肌皮瓣转移乳房重建术在确保手术疗效的同时,能让患者乳房保持良好形态,提升患者自尊水平及自我形象要求,改善乳腺癌患者的生活质量,值得在临床推广。

Objective To explore the effect of super-quadrant breast-conserving resection combined with pedicled latissimus dorsi musculocutaneous flap for breast reconstruction on the cosmetic and prognosis of breast cancer.Methods 50 patients with breast cancer who underwent super-quadrant breast-conserving resection with pedicled latissimus dorsi musculocutaneous flap for breast reconstruction were selected as the observation group.Another 50 patients who underwent traditional breast conserving surgery at the same time were selected as the control group.The incidence of postoperative complications,cosmetic effect of breast,prognosis,self-esteem and self-image before and after surgery were compared between the two groups.Results The cosmetic effect of breast in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).The incidence rates of postoperative infection,skin flap necrosis,poor wound healing and subcutaneous fluid were compared between the two groups,and the difference was not statistically significant(P>0.05).There was no significant difference in distant metastasis,recurrence metastasis and survival between the two groups(P>0.05).Before surgery,there was no significant difference in the scores of body image after breast cancer questionnaire(BIBCQ)and self-esteem scale(SES)between the two groups(P>0.05).After surgery,the observation group had significantly lower BIBCQ score of(98.56±8.88)points than(121.31±9.18)points in the control group,and significantly higher SES score of(30.85±3.86)points than(24.65±3.15)points in the control group.The difference was statistically significant(P<0.05).Conclusion Super-quadrant breast-conserving resection combined with ppedicled latissimus dorsi musculocutaneous flap for breast reconstruction for breast cancer patients can not only ensure the curative effect of surgery,but also keep the breast in good shape,improve the self-esteem,self-image and the quality of life of patients,which is worthy of clinical promotion.