植入物乳房重建一步法和二步法临床对比研究  

Clinical comparative study of one-step and two-step methods for implant breast reconstruction

作　　者：李宇翔 丰锦春 朱丽萍[1] 许文婷[1] 吐鲁洪·沙列尔[1] 努尔比亚·尼亚孜 郁璐月 吴涛[1] Li Yuxiang;Feng Jinchun;Zhu Liping;Xu Wenting;Tuluhong·Shalie'er;Nuerbiya·Niyazi;Yu Luyue;Wu Tao(Department of Breast Surgery,Affiliated Tumor Hospital of Xinjiang Medical University,Xinjiang Urumqi 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院乳腺外科,新疆乌鲁木齐830011

出　　处：《现代肿瘤医学》2020年第10期1668-1673,共6页Journal of Modern Oncology

基　　金：新疆维吾尔自治区自然科学基金资助项目(编号:2018D01C264)。

摘　　要：目的:探讨即刻乳房假体重建(一步法)和应用扩张器的假体重建(二步法)两种不同手术方式在术后并发症、美容效果和成本效益的差异。方法:回顾性分析我院乳腺外科2015年5月至2018年5月收治的285例乳腺癌植入物重建患者,依据手术方式不同分为一步法组(145例)和二步法组(140例),比较两组患者临床资料的差异。结果:一步法组术后出血发生率(6.8%)高于二步法组(1.4%),差异有统计学意义(P=0.021)。一步法组术后伤口皮瓣坏死率(6.2%)高于二步法组(1.4%),差异有统计学意义(P=0.036)。二步法组乳房满意度评分(81.5±7.1)分高于1步法组(78.6±6.2)分,差异有统计学意义(P=0.035)。二步法组住院总花费(80334.8±6149.8)元高于一步法组(60966.5±5544.9)元,差异有统计学意义(P=0.049)。二步法组住院天数(34.3±3.2)天多于一步法组(17.5±3.9)天,差异有统计学意义(P=0.014)。结论:在植入物乳房重建两种手术方式中,二步法相较于一步法,其并发症少,美容效果好,但在成本效益上并不优于一步法。Objective:To investigate the difference of postoperative complications,cosmetic effects and cost-effectiveness between two different surgical methods:Immediate breast reconstruction(one-step method)and prosthesis reconstruction with dilator(two-stepmethod).Methods:A retrospective analysis of 285 patients with the reconstruction of breast cancer implants in our hospital from May 2015 to May 2018 was divided into one-step group(145 cases)and two-stepmethod group(140 cases)according to different surgical methods.Clinical data was compared between the two groups.Results:The incidence of postoperative bleeding in the one-step group was 6.8%which was significantly higher than that in the two-step group(1.4%)(P=0.021).The rate of wound flap necrosis(6.2%)was significantly higher in the one-step group than in the two-step group(1.4%)(P=0.036).The breast satisfaction score of the two-step group(81.5±7.1)points was significantly higher than that of the one-step group(78.6±6.2)points,P=0.035.The total cost of hospitalization in the two-step group(80334.8±6149.8)yuan was significantly higher than that in the one-step group(60966.5±5544.9)yuan,P=0.049.The length of hospital stay in the two-step group(34.3±3.2)days was more than one-step group(17.5±3.9)days,respectfully,P=0.014.Conclusion:The two-step method has fewer complications and better cosmetic effect than the one-step method,but it is not superior to the one-step method in cost-effectiveness within the two surgical methods of implant breast reconstruction.

关 键 词：乳腺癌 乳房重建 假体植入 扩张器 手术并发症 

分 类 号：R737.9[医药卫生—肿瘤]