游离腹部皮瓣乳房重建术后脂肪坏死发生的危险因素探讨  

Assessment of risk factors for fat necrosis in free abdominal flap breast reconstruction

作　　者：陈颖[1] 李琳[1] 陈嘉莹[1] 胡震[1] 陈灿铭[1] 柳光宇[1] 沈镇宙[1] 邵志敏[1] 吴炅[1] 

机构地区：[1]复旦大学附属肿瘤医院乳腺外科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《癌症进展》2013年第5期411-419,共9页Oncology Progress

摘　　要：目的脂肪坏死是游离腹部皮瓣乳房重建术后常见的并发症之一，导致其发生的危险因素众多，且仍存在许多争议。我们通过回顾接受游离腹部皮瓣乳房重建术，且有完整术后随访记录的乳腺肿瘤患者，以了解该重建术式后重建乳房脂肪坏死的发生率，并寻找潜在的危险因素。方法收集白2010年5月至2012年10月在复旦大学附属肿瘤医院接受游离腹部皮瓣乳房重建的79位患者的资料，包括住院记录、门诊随访记录、病理及其他辅助检查结果等，评估重建乳房脂肪坏死的发生率，并通过多因素回归分析寻找潜在的危险因素。结果80例游离腹部皮瓣乳房重建术中，共有29例（36．25％）发生脂肪坏死，其中20例脂肪坏死硬结在随访中自行缓解或消退。多因素回归分析显示，术后辅助化疗是术后发生脂肪坏死的独立预测因素，相对危险度为5．476（多因素Logistic回归模型；95％可信区间为1．902～15．766；P=0．009）。结论术后辅助化疗可显著增加游离腹部皮瓣乳房重建术后脂肪坏死的发生率。临床医师在选择乳房重建时机时，应重视辅助化疗对重建乳房的影响，在辅助化疗指征的把握、方案的拟定以及开始时间的选择上应更为慎重。Objective Fat necrosis is one of the most common complications of free abdominal flap breast recon- struction. Lots of factors were considered to increase the incidence of fat necrosis. However there were still controversies. We would like to review the successful cases of free abdominal flap breast reconstructions with follow-ups to determine the incidence rate of this complication and its risk factors. Method We retrospectively studied the 80 consecutive cases of free abdominal flap breast reconstructions in Fudan University Shanghai Cancer Center from May 2010 to October 2012. Data were collected from patients＇ surgical records, ward reports and clinic notes, etc. Result The incidence rate of fat necrosis was 36. 25%. In these 29 lesions, 20 of them disappeared or were alleviated. Adjuvant chemotherapy significantly increased the risk of fat necrosis by 5. 476 times （ multivariate logistic regression model, 95% CI ： 1. 902 - 15. 766, P = 0. 009）. Conclusion Adjuvant chemotherapy was the independent predictive factor of fat necrosis. More attentions should be paid to adjuvant chemotherapy when deciding the timing of reconstruction, including the indication, the choice of regimens and the interval between operation and adjuvant chemotherapy.

关 键 词：乳腺癌 乳房重建 游离组织皮瓣 显微外科 术后并发症 脂肪坏死 危险因素 辅助化疗 

分 类 号：R737.9[医药卫生—肿瘤]