摘要
目的探讨乳腺癌术后自体组织即刻乳房重建(IBR)与延期重建(DBR)的疗效及其对患者相关生活质量的影响。方法选取行择期乳腺癌根治手术患者106例,随机分为即刻组与延期组,每组各53例。即刻组于乳腺癌术后采用自体组织进行即刻乳房重建,延期组于乳腺癌术后1年再采用自体组织行乳房重建。术后6个月时,评价两组患者的临床疗效,包括重建乳房、腋窝、腋周及锁骨区域形态,以及上肢活动和术后并发症等,评价患者对重建乳房的状态的满意度;采用欧洲癌症研究治疗组织制定的生活质量问卷调查条例(EORTC QOL-C30)评价患者的相关生活质量,包括角色功能、情绪状态、社会功能评价。结果即刻组与延期组分别随访(8.4±1.2)个月、(8.1±1.0)个月,随访率分别为96.23%、92.45%。两组患者术后重建乳房组织均成活,无肌皮瓣坏死、感染、血肿等术后并发症出现,乳房及供区切口均I期愈合。肉眼观双侧胸前壁基本对称,乳房外观自然,无明显包膜挛缩征象;重建的腋前皱璧与健侧基本对称,腋窝顶部与腋前皱璧凹陷畸形已纠正;锁骨下区域形态较术前明显改观;上肢活动无明显功能障碍。术后6个月时,即刻组患者对重建乳房的状态,包括总体满意度、外形满意度、对称满意度、瘢痕满意度均高于延期组,即刻组患者生活质量,包括角色功能、情绪状态、社会功能评价均高于延期组,差异均具有统计学意义(P<0.05)。结论乳腺癌术后自体组织即刻乳房重建具有确切的临床效果,且患者对重建乳房的状态和相关生活质量均优于延期乳房重建。多数情况下,患者可选择即时手术,对于晚期需要大剂量放化疗者,则可待病情稳定后考虑行延期乳房再造。
Objective To explore the clinical effect of immediate （IBR） and delayed breast reconstruction （DBR） with autologous tissue after breast cancer＇s operation and its influence on patients＇ related quality of life. Methods 106 patients with elective breast cancer operation were included and randomly divided into IBR group and DBR group, 53 cases per group. Patients in IBR group were given IBR with autologous tissue after breasi cancer＇s operation, while patients in DBR group were given DBR with autolognus tissue one year after breasl cancer＇s operation. Two groups＇ clinical effect were evaluated 6 months after operation, including the form of reconstructed breast, axillary, axilla and supraclavicular regions, also in- cluding upper limb activity, postoperative complications, and patient satisfaction on reconstructed breast. Patients＇ related quality of life were evaluat- ed by EORTC QOL-C30, including evaluation of role function, emotional state and social function. Results Two groups＇ reconstructed breast all survived after operation, without muscle skin flap necrosis, infection, hematoma and other complications. The wound of breast and donor site were all healed on phase I. Bilateral anterior chest wall were symmetry by eye view, and the appearance were normal, without obvious signs of capsular con- tracture. Reconstructed anterior axillary folds were symmetry with contralaterai folds, the sunken malformation were corrected, subclavian regional morphology was significantly improved, and upper limb activities have no obvious dysfunction. 6 months after operation, IBR group＇s satisfaction on reconstructed breast and quality of life were both higher than that of DBR group （P〈0.05）. Conclusion IBR with autologous tissue afler breast can- cer＇s operation has exact clinical effects. The patients＇ satisfaction on reconstructed breast and quality of life were both higher than that of DBR group. In most cases, patients can choose IBR. The patitents need high dose chemotherapy can consider DBR when the condition is stable.
出处
《浙江创伤外科》
2013年第6期794-797,共4页
Zhejiang Journal of Traumatic Surgery
关键词
乳腺癌
乳房重建
自体组织
重建时机
生活质量
Breast cancer
Breast reconstruction
Antologous tissue
Reconstruction opportunity
Quality of life
