腔镜下双平面假体植入与胸肌前假体植入乳房重建的前瞻性对比研究

Prospective comparative study of breast reconstruction with dual plane prosthesis implantation and anterior pectoralis prosthesis implantation under endoscopy

目的采用前瞻性对比研究,探讨腔镜下双平面假体植入与胸肌前假体植入乳房重建的疗效差异,以期为临床术式选择提供参考。方法以2023年1月—12月收治的乳腺癌患者为研究对象,其中54例女性患者符合选择标准纳入研究,采用随机数字表法均分为试验组及对照组(n=27),腔镜下腺体切除后分别采用双平面假体植入、胸肌前假体植入重建乳房。两组患者年龄、身体质量指数、侧别、乳腺癌临床分期、分子分型、病程、健侧乳房体积、患侧乳房下垂度及术前Breast-Q评分(社会心理健康、性健康、乳房满意度、胸部躯体健康)等基线资料比较,差异均无统计学意义(P>0.05)。比较两组手术相关指标(手术时间、术后7 d内总引流量、拔管时间和住院时间)、并发症发生情况、乳房重建疗效相关指标(乳头横、纵向距离差),以及Breast-Q评分各项目手术前后差值(变化值)。结果两组手术时间、术后7 d内总引流量、拔管时间和住院时间差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间3~12个月,平均6.3个月。试验组3例(11.11%)、对照组5例(18.52%)发生相关并发症,并发症发生率差异无统计学意义(P>0.05)。术后7 d,试验组乳头横、纵向距离差均小于对照组(P<0.05);两组Breast-Q评分各项目均高于术前(P<0.05),但组间各项目变化值差异均无统计学意义(P>0.05)。结论对于乳腺癌患者,与胸肌前假体植入重建乳房相比,腔镜下双平面假体植入乳房重建效果较好,安全性较高。

Objective To discuss the effectiveness of breast reconstruction with dual plane prosthesis implantation or anterior pectoralis prosthesis implantation under endoscopy by using prospective comparative study,in order to provide a reference for clinical surgical selection.Methods A total of 54 female patients with breast cancer admitted between January 2023 and December 2023 and met the selection criteria were selected as research subjects.According to the random number table,54 patients were divided into trial group and control group with 27 cases in each.The patients in the trial group and control group were treated with dual plane prosthesis implantation and anterior pectoralis prosthesis implantation for breast reconstruction after glandular resection under endoscopy,respectively.There was no significant difference between the two groups(P>0.05)in the terms of age,body mass index,affected side,breast clinical stages,molecular typing,disease duration,breast volume of healthy side,breast ptosis of affected side,and preoperative Breast-Q score(social mental health,sexual health,breast satisfaction,chest somatic health).The operationrelated indicators(operation time,total volume of drainage within 7 days after operation,extubation time,and hospital stay),occurrence of complications,breast reconstruction efficacy related indicators(transverse and longitudinal distance difference),and the pre-and post-operative differences(change values)of Breast-Q scores for each item were compared between the two groups.Results There was no significant difference in operation time,total volume of drainage within 7 days after operation,extubation time,and hospital stay between the two groups(P>0.05).All patients of the two groups were followed up 3-12 months(mean,6.3 months).Three patients(11.11%)in trial group and 5 patients(18.52%)in control group experienced complications,and there was no significant difference in the occurrence of complications(P>0.05).At 7 days after operation,the transverse and longitudinal distance differences were significantly less in trial group than in control group(P<0.05).The Breast-Q scores of the two groups at 7 days after operation were significantly higher in all items than those before operation(P<0.05),but there was no significant difference in all change values between the two groups(P>0.05).Conclusion For patients with breast cancer,comparison of breast reconstruction with anterior pectoralis prosthesis implantation,breast reconstruction with dual plane prosthesis implantation has better breast reconstruction effectiveness and higher safety.