目的:探讨乳腺癌保乳术后缺损创面采用不同皮瓣修复的美观性。方法:选取笔者医院120例行保乳术治疗的乳腺癌患者随机分为观察组(65例)与对照组(55例)。术前对患者的肿瘤位置、分期、大小及表面皮肤张力情况进行分析,确定并标记切除位置...目的:探讨乳腺癌保乳术后缺损创面采用不同皮瓣修复的美观性。方法:选取笔者医院120例行保乳术治疗的乳腺癌患者随机分为观察组(65例)与对照组(55例)。术前对患者的肿瘤位置、分期、大小及表面皮肤张力情况进行分析,确定并标记切除位置和范围。对照组采用背阔肌皮瓣修复,观察组采用侧胸壁脂肪筋膜皮瓣修复。记录两组手术时间、术中出血量及住院时间,于手术6个月后采用乳腺美学评估标准(Rose评估标准)评估乳房美学效果,采用温哥华瘢痕量表(Vancouver scar scale,VSS)评估患者乳房美观度(色泽、血管、柔软度、厚度、疼痛及瘙痒),采用健康调查简表(the MOS item short from health survey,SF-36)评估患者生活质量,并记录两组术后6个月内并发症发生情况。结果:观察组手术时间、术中出血量及住院时间显著低于对照组,差异有统计学意义(P<0.05)。手术6个月后观察组乳房美学效果优良率为83.08%,显著高于对照组的65.45%,差异有统计学意义(P<0.05)。手术6个月后观察组色泽、血管、柔软度、厚度、疼痛及瘙痒评分均低于对照组,且SF-36各维度评分显著高于对照组,差异均有统计学意义(P<0.05)。术后6个月内观察组并发症发生率显著低于对照组,差异有统计学意义(P<0.05)。结论:侧胸壁脂肪筋膜皮瓣转移法对乳腺癌保乳术后缺损乳房进行修复时患者乳房美观度更高,术后并发症更少。展开更多
Pectus excavatum (PE) and pectus carinatum (PC) are relatively common deformities involving the anterior chest wall, occurring in 1:1000 and 1:1500 live births, respectively. While the etiology remains an enigma, the ...Pectus excavatum (PE) and pectus carinatum (PC) are relatively common deformities involving the anterior chest wall, occurring in 1:1000 and 1:1500 live births, respectively. While the etiology remains an enigma, the association of pectus deformities with other skeletal abnormalities suggests that connective tissue disease may play a role in their pathogenesis. Clinical features of these deformities vary with severity, as determined by the Haller index and Backer ratio, but frequently include cardiac and respiratory abnormalities. Importantly, there exist profound psychosocial implications for children afflicted with these defofrmities, including but not limited to feelings of embarrassment and maladaptive social behaviors. These debilitating characteristics have prompted the development of novel medical and surgical corrective techniques. The correction of pectus deformities reduces the incidence of physiological complications secondary to chest wall malformation, while simultaneously improving body image and psychosocial development in the affected pediatric population. The Ravitch (open) and Nuss (minimally invasive) procedures remain the most frequently employed methods of pectus deformity repair, with no difference in overall complication rates, though individual complication rates vary with treatment. The Nuss procedure is associated with a higher rate of recurrence due to bar migration, hemothorax, and pneumothorax. Postoperative pain management is markedly more difficult in patients who have undergone Nuss repair. Patients undergoing the Ravitch procedure require less postoperative analgesia, but have longer operation times and a larger surgical scar. The cosmetic results of the Nuss procedure and its minimally invasive nature make it preferable to the Ravitch repair. Newer treatment modalities, including the vacuum bell, magnetic mini-mover procedure (3MP), and dynamic compression bracing (DCB) appear promising, and may ultimately provide effective methods of noninvasive repair. However, these modalities suffer from a lack of extensive published evidence, and the limited number of studies currently published fail to adequately define their long-term effectiveness.展开更多
文摘目的:探讨乳腺癌保乳术后缺损创面采用不同皮瓣修复的美观性。方法:选取笔者医院120例行保乳术治疗的乳腺癌患者随机分为观察组(65例)与对照组(55例)。术前对患者的肿瘤位置、分期、大小及表面皮肤张力情况进行分析,确定并标记切除位置和范围。对照组采用背阔肌皮瓣修复,观察组采用侧胸壁脂肪筋膜皮瓣修复。记录两组手术时间、术中出血量及住院时间,于手术6个月后采用乳腺美学评估标准(Rose评估标准)评估乳房美学效果,采用温哥华瘢痕量表(Vancouver scar scale,VSS)评估患者乳房美观度(色泽、血管、柔软度、厚度、疼痛及瘙痒),采用健康调查简表(the MOS item short from health survey,SF-36)评估患者生活质量,并记录两组术后6个月内并发症发生情况。结果:观察组手术时间、术中出血量及住院时间显著低于对照组,差异有统计学意义(P<0.05)。手术6个月后观察组乳房美学效果优良率为83.08%,显著高于对照组的65.45%,差异有统计学意义(P<0.05)。手术6个月后观察组色泽、血管、柔软度、厚度、疼痛及瘙痒评分均低于对照组,且SF-36各维度评分显著高于对照组,差异均有统计学意义(P<0.05)。术后6个月内观察组并发症发生率显著低于对照组,差异有统计学意义(P<0.05)。结论:侧胸壁脂肪筋膜皮瓣转移法对乳腺癌保乳术后缺损乳房进行修复时患者乳房美观度更高,术后并发症更少。
文摘Pectus excavatum (PE) and pectus carinatum (PC) are relatively common deformities involving the anterior chest wall, occurring in 1:1000 and 1:1500 live births, respectively. While the etiology remains an enigma, the association of pectus deformities with other skeletal abnormalities suggests that connective tissue disease may play a role in their pathogenesis. Clinical features of these deformities vary with severity, as determined by the Haller index and Backer ratio, but frequently include cardiac and respiratory abnormalities. Importantly, there exist profound psychosocial implications for children afflicted with these defofrmities, including but not limited to feelings of embarrassment and maladaptive social behaviors. These debilitating characteristics have prompted the development of novel medical and surgical corrective techniques. The correction of pectus deformities reduces the incidence of physiological complications secondary to chest wall malformation, while simultaneously improving body image and psychosocial development in the affected pediatric population. The Ravitch (open) and Nuss (minimally invasive) procedures remain the most frequently employed methods of pectus deformity repair, with no difference in overall complication rates, though individual complication rates vary with treatment. The Nuss procedure is associated with a higher rate of recurrence due to bar migration, hemothorax, and pneumothorax. Postoperative pain management is markedly more difficult in patients who have undergone Nuss repair. Patients undergoing the Ravitch procedure require less postoperative analgesia, but have longer operation times and a larger surgical scar. The cosmetic results of the Nuss procedure and its minimally invasive nature make it preferable to the Ravitch repair. Newer treatment modalities, including the vacuum bell, magnetic mini-mover procedure (3MP), and dynamic compression bracing (DCB) appear promising, and may ultimately provide effective methods of noninvasive repair. However, these modalities suffer from a lack of extensive published evidence, and the limited number of studies currently published fail to adequately define their long-term effectiveness.
