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 reconstr...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。展开更多
乳房重建手术已逐渐发展为乳腺癌手术治疗中的一个重要手段。近些年,随着乳房重建手术数量的增加,双侧乳房重建手术(bilateral breast reconstruction,BBR)的比例也在不断提高,而预防性乳腺切除术和双侧乳腺癌发病率的增长是双侧乳房重...乳房重建手术已逐渐发展为乳腺癌手术治疗中的一个重要手段。近些年,随着乳房重建手术数量的增加,双侧乳房重建手术(bilateral breast reconstruction,BBR)的比例也在不断提高,而预防性乳腺切除术和双侧乳腺癌发病率的增长是双侧乳房重建手术增加的主要原因。本文将就BBR的临床指征、重建方式、手术并发症和远期效果等方面进行综述。展开更多
Objectives: To investigate in a retrospective study the technical aspects of using the in situ bilateral internal mammary arteries(IMAs), with the right IMA(RIMA) used for revascularisation of the circumflex system, a...Objectives: To investigate in a retrospective study the technical aspects of using the in situ bilateral internal mammary arteries(IMAs), with the right IMA(RIMA) used for revascularisation of the circumflex system, and to evaluate early and late outcome. Materials and methods: Between January 1997 and July 2003, 552 consecutive patients underwent grafting of the circumflex artery system with an in situ skeletonised RIMA routed through the transverse sinus(eventually retrocaval). Mean(SD) age was 63.8(11) years. 331(60%) patients underwent total arterial myocardial revascularisation. Mean follow up was 26(9) months. Results: The success rate of skeletonised RIMA grafting to the circumflex branch was 100%. There were 19(3.4%) in-hospital deaths. Perioperative myocardial infarction occurred in 12(2.2%) patients. In 155 patients undergoing postoperative angiography, two had an occluded RIMA and a string-like phenomenon was seen in three RIMA and one left IMA(LIMA). Three RIMA and three LIMA had stenotic lesions. The patency rates of RIMA and LIMA were 94%and 97.4%, respectively. Strong predictors of non-functional IMA grafts were a recipient coronary artery diameter of< 1.5 mm(p=0.022),< 60%stenosis of the recipient coronary artery(p=0.015), diffuse stenotic lesions of the recipient coronary artery(p=0.018), and a small IMA calibre(p=0.0001). Cumulative actuarial survival at three years was 96.4%and event-free cumulative survival was 93.8%. Conclusions: Use of the bilateral IMAs offers the possibility of constructing various configurations, making total arterial myocardial revascularisation possible with a minimum number of arterial conduits. Use of the skeletonised RIMA through the transverse sinus and eventually retrocavally can reach most branches of the circum-flex system and is associated with an excellent patency rate. Patients who received bilateral IMA grafts for left coronary system revascularisation had improved early and late outcomes and decreased risk of death, reoperation, and angioplasty.展开更多
文摘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。
文摘乳房重建手术已逐渐发展为乳腺癌手术治疗中的一个重要手段。近些年,随着乳房重建手术数量的增加,双侧乳房重建手术(bilateral breast reconstruction,BBR)的比例也在不断提高,而预防性乳腺切除术和双侧乳腺癌发病率的增长是双侧乳房重建手术增加的主要原因。本文将就BBR的临床指征、重建方式、手术并发症和远期效果等方面进行综述。
文摘Objectives: To investigate in a retrospective study the technical aspects of using the in situ bilateral internal mammary arteries(IMAs), with the right IMA(RIMA) used for revascularisation of the circumflex system, and to evaluate early and late outcome. Materials and methods: Between January 1997 and July 2003, 552 consecutive patients underwent grafting of the circumflex artery system with an in situ skeletonised RIMA routed through the transverse sinus(eventually retrocaval). Mean(SD) age was 63.8(11) years. 331(60%) patients underwent total arterial myocardial revascularisation. Mean follow up was 26(9) months. Results: The success rate of skeletonised RIMA grafting to the circumflex branch was 100%. There were 19(3.4%) in-hospital deaths. Perioperative myocardial infarction occurred in 12(2.2%) patients. In 155 patients undergoing postoperative angiography, two had an occluded RIMA and a string-like phenomenon was seen in three RIMA and one left IMA(LIMA). Three RIMA and three LIMA had stenotic lesions. The patency rates of RIMA and LIMA were 94%and 97.4%, respectively. Strong predictors of non-functional IMA grafts were a recipient coronary artery diameter of< 1.5 mm(p=0.022),< 60%stenosis of the recipient coronary artery(p=0.015), diffuse stenotic lesions of the recipient coronary artery(p=0.018), and a small IMA calibre(p=0.0001). Cumulative actuarial survival at three years was 96.4%and event-free cumulative survival was 93.8%. Conclusions: Use of the bilateral IMAs offers the possibility of constructing various configurations, making total arterial myocardial revascularisation possible with a minimum number of arterial conduits. Use of the skeletonised RIMA through the transverse sinus and eventually retrocavally can reach most branches of the circum-flex system and is associated with an excellent patency rate. Patients who received bilateral IMA grafts for left coronary system revascularisation had improved early and late outcomes and decreased risk of death, reoperation, and angioplasty.
