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乳腺癌术后即刻背阔肌皮瓣联合假体植入与带蒂腹直肌皮瓣乳房重建的疗效比较 被引量:2

A comparative study on the effect of breast reconstruction with latissimus dorsi flap combined with prosthesis and transverse rectus abdominis myocutaneous flap in immediate breast cancer surgery
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摘要 目的比较乳腺癌术后背阔肌皮瓣(latissimus dorsi flap,LDF)联合假体植入与带蒂腹直肌皮瓣(transverse rectus abdominis muscle,TRAM)乳房重建的临床疗效。方法分析2015年1月到2020年6月重庆医科大学附属第一医院乳腺甲状腺外科手术治疗的女性乳腺癌术后即刻乳房自体重建患者的临床资料。按乳房重建手术方式分为LDF+假体组(n=75)和TRAM组(n=35);收集两组患者的基本信息、手术时长、失血量、术后开始辅助治疗时间、术后并发症、美学评价、局部复发率、远处转移率、死亡率等进行分析,比较两种手术的疗效。结果LDF+假体重建组与TRAM组患者的总生存率分别为97.3%与94.3%(χ^(2)=0.63,P=0.426);美学评价优良比分别为84.6%与93.8%(χ^(2)=2.56,P=0.465),差异均无统计学意义。LDF+假体重建组患者手术平均时长为262min,低于TRAM组的284min(t=-2.04,P=0.044);LDF+假体重建组患者失血量平均值为92 mL,低于TRAM组的136 mL(t=-3.31,P=0.001);术后并发症发生情况比较,LDF+假体重建组的发生率低于TRAM组(10.7%vs.25.7%,χ^(2)=4.14,P=0.042),术后开始辅助治疗时间也早于TRAM组(10.5 d vs.21.2 d,t=-6.63,P<0.001),差异均有统计学意义。结论乳腺癌术后即刻LDF+假体乳房重建术与TRAM乳房重建术均可获得较好的乳房美学效果,两种手术方式术后并发症均较少,安全性高。 Objective To compare the clinical effect of breast reconstruction of latissimus dorsi flap combined with prosthetic implantation and transverse rectus abdominis muscle(TRAM)after breast cancer surgery.Methods 110 female patients with breast cancer from Jan.2015 to Jun.2020 were treated with breast cancer reconstruction in the First Affiliated Hospital of Chongqing Medical University.According to the surgical method of breast reconstruction,it was divided into latissimus dorsi flap combined with prosthesis implantation group(n=75)and TRAM group(n=35).The basic information,surgical procedure,operation duration,course of adjuvant chemotherapy,postoperative complications,aesthetic effect and the rate of local recurrence,distant metastasis and mortality were compared between these two groups.Results There was no significant difference in prognosis(97.3%vs.94.3%,χ^(2)=0.63,P=0.426)and aesthetic evaluation(84.6%vs.93.8%,χ^(2)=2.56,P=0.465)between the group of latissimus dorsi flap combined with prosthesis implantation group and TRAM group.The average duration of surgery for patients in the latissimus dorsi flap combined with prosthesis implantation group was 262 min,which was lower than that in the TRAM group(284 min)(t=-2.04,P=0.044).The latissimus dorsi flap combined with prosthesis implantation group was better than the TRAM group in terms of the mean blood loss(92 mL vs.136 mL,t=-3.31,P=0.001).When comparing postoperative complications,the rate of incidence in the latissimus dorsi flap combined with prosthesis implantation group was lower than that in the TRAM group(10.7%vs.25.7%,χ^(2)=4.14,P=0.042),and the initiation of adjuvant therapy was earlier in the latissimus dorsi flap combined with prosthesis implantation group than in the TRAM group(10.5 d vs.21.2 d,t=-6.63,P<0.001),with statistically significant differences observed in the two groups.Conclusion Latissimus dorsi flap combined with prosthesis implantation and TRAM can obtain better breast aesthetic effects,which are reliable methods for immediate breast reconstruction with high safety and few postoperative complications.
作者 梁馨予 魏余贤 魏庭庭 张恒 张艾洁 李云海 孔令泉 厉红元 李凡 Liang Xinyu;Wei Yuxian;Wei Tingting;Zhang Heng;Zhang Aijie;Li Yunhai;Kong Lingquan;Li Hongyuan;Li Fan(Department of Breast and Thyroid Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Health Management Centre,the University-Town Hospital of Chongqing Medical University,Chongqing 401333,China)
出处 《中华内分泌外科杂志(中英文)》 CAS 2024年第2期178-183,共6页 Chinese Journal of Endocrine Surgery
基金 重庆市2021年科卫联合医学科研项目(2021MSXM067)。
关键词 乳腺癌 乳房重建 背阔肌皮瓣 假体 腹直肌皮瓣 Breast cancer Breast reconstruction Latissimus dorsi flap Prosthesis Transverse rectus abdominis myocutaneous flap
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