不同即刻乳房重建术在乳腺癌改良根治术后的应用效果

Application Effects of Different Immediate Breast Reconstruction After Modified Radical Resection of Breast Cancer

目的分析不同即刻乳房重建术在乳腺癌改良根治术后的应用效果及并发症发生情况。方法纳入许昌市中心医院2017年1月至2023年1月收治的70例乳腺癌患者,随机分为双平面组和背阔肌组,各35例,双平面组患者于乳腺癌改良根治术后即刻实施胸大肌-胸外侧融合筋膜系统覆盖假体乳房重建术,背阔肌组患者于乳腺癌改良根治术后即刻实施部分背阔肌覆盖假体乳房重建术,并随访1 a。比较两组患者围手术期指标(假体体积、手术耗时、出血量、引流量、住院时间),患者乳房美容满意度(Harris乳房美容评分),随访期间患者二次手术率、假体丢失率、并发症总发生率(术后感染、术后出血、假体移位、包膜挛缩、皮瓣淤血),以及局部复发率、远端转移率。结果双平面组患者假体体积高于背阔肌组,手术耗时、住院时间短于背阔肌组,出血量、引流量少于背阔肌组(P<0.05)。双平面组患者乳房美容满意度高于背阔肌组(P<0.05)。随访1 a期间,两组患者二次手术率、假体丢失率比较,差异无统计学意义(P>0.05);双平面组患者并发症总发生率低于背阔肌组(P<0.05)。两组患者局部复发率、远端转移率比较,差异无统计学意义(P>0.05)。结论双平面乳房重建术用于乳腺癌改良根治术后具有损伤小、术后恢复快等优势,且可提高患者满意度,并降低术后并发症发生风险。

Objective To analyze the effects and complications of different immediate breast reconstruction after modified radical resection of breast cancer.Methods A total of 70 patients with breast cancer admitted to Xuchang Central Hospital from January 2017 to January 2023 were randomly divided into the biplane group and the latissimus dorsi group,35 cases in each group.The biplane group underwent breast reconstruction with pectoralis maximus-lateral pectoralis fusion fascial system covering prosthesis immediately after modified radical breast cancer surgery.The latissimus dorsi group underwent breast reconstruction with partial latissimus dorsi covering prosthesis immediately after modified radical mastectomy,and were followed up for a year.Perioperative indexes(prosthesis volume,surgical time,blood loss,drainage volume,length of hospital stay),patients’satisfaction with breast beauty(Harris breast beauty score),rate of second surgery,prosthesis loss,total incidence of complications(postoperative infection,postoperative bleeding,prosthesis displacement,capsular contracture,and flap stasis),and local recurrence rate,remote metastasis rate were compared between the two groups.Results The prosthesis volume in biplane group was higher than that in latissimus dorsi group,and the operation time,hospital stay were shorter than those in latissimus dorsi group,blood loss,drainage volume were less than those in latissimus dorsi group(P<0.05).The satisfaction of breast beauty in biplane group was higher than that in latissimus dorsi group(P<0.05).During the follow-up period of 1 year,there was no significant difference in the rate of second operation and prosthesis loss between the two groups(P>0.05).The total complication rate of biplane group was lower than latissimus dorsi group(P<0.05).There was no significant difference in local recurrence rate and remote metastasis rate between two groups(P>0.05).Conclusion Biplanar breast reconstruction has the advantages of less damage and faster recovery after modified radical breast cancer surgery,and can improve patient satisfaction and reduce the risk of postoperative complications.