早期乳腺癌术后胸大肌筋膜联合前锯肌脂肪筋膜瓣假体植入的乳房重建效果  

Effects of implantation of pectoralis major fascia combined with serratus anterior fatty fascia flap prosthesis on breast reconstruction after early breast cancer surgery

作　　者：邓润枢[1] 邓丁梅[1] 王永霞[1] 钟慕仪[1] 何广宁[1] 宾莲洁 叶俊杰 张爱玲[1] Deng Runshu;Deng Dingmei;Wang Yongxia;Zhong Muyi;He Guangning;Bin Lianjie;Ye Junjie;Zhang Ailing(Department of Breast Cancer,Dongguan People's Hospital of Guangdong Province,Dongguan 523000,China)

机构地区：[1]广东省东莞市人民医院乳腺科,523000

出　　处：《肿瘤研究与临床》2021年第6期428-433,共6页Cancer Research and Clinic

基　　金：广东省医学科学技术研究基金(20171023195919181)。

摘　　要：目的:探讨早期乳腺癌术后胸大肌筋膜联合前锯肌脂肪筋膜瓣假体植入的乳房重建效果。方法:选取2017年7月至2019年12月广东省东莞市人民医院收治的62例拟行乳房重建术的早期乳腺癌患者,按照随机数字表法分为对照组和观察组,每组各31例,其中对照组采用胸大肌筋膜覆盖包裹假体行乳房重建,观察组采用胸大肌筋膜联合前锯肌脂肪筋膜瓣覆盖包裹假体行乳房重建。记录两组患者临床资料,评估术后乳房美学外观情况,根据乳腺癌患者生命质量测定量表(FACT-B)评估患者手术前后生命质量评分,并观察术后并发症发生情况。结果:对照组和观察组术中出血量分别为(82.61±12.38)ml、(88.76±13.57)ml,引流管拔管时间分别为(3.51±0.62)d、(3.64±0.58)d,两组比较差异均无统计学意义(t值分别为1.864、0.853,均P>0.05);观察组手术时间长于对照组[(2.59±0.29)h比(1.72±0.32)h,t=11.217,P<0.001],对照组引流量高于观察组[(215.45±47.69)ml比(151.36±31.67)ml,t=6.233,P<0.001],对照组住院时间长于观察组[(14.51±2.32)d比(10.79±1.86)d,t=6.965,P<0.001]。观察组术后乳房外观优良率高于对照组[96.77%(30/31)比74.19%(23/31),χ^(2)校正=4.679,P=0.031]。两组术前FACT-B各项目(健康、情感、功能、社会/家庭、其他状况)及总评分比较,差异均无统计学意义(均P>0.05),两组术后各项目及总评分均高于术前(均P<0.001),且术后观察组评分均高于对照组(均P<0.001)。观察组术后并发症总发生率为6.45%(2/31),与对照组的22.58%(7/31)比较,差异无统计学意义(χ^(2)校正=2.080,P=0.149)。结论:采用胸大肌筋膜联合前锯肌脂肪筋膜瓣假体植入进行早期乳腺癌术后乳房重建,可缩短患者术后住院时间,提高乳房美学外观,改善患者远期生命质量,且安全性较高。Objective To investigate effects of implantation of pectoralis major fascia combined with serratus anterior fatty fascia flap prosthesis on breast reconstruction after early breast cancer surgery.Methods A total of 62 patients with early breast cancer undergoing breast reconstruction in Dongguan People's Hospital of Guangdong Province from July 2017 to December 2019 were selected and randomly divided into two groups,31 cases in each group.The control group was treated with pectoralis major fascia covering prosthesis for breast reconstruction,and the observation group was treated with pectoralis major fascia combined with serratus anterior fatty fascia flap covering prosthesis for breast reconstruction.The clinical data of the two groups were recorded,the postoperative aesthetic appearance of breast was evaluated.According to the function assessment of cancer therapy-breast cancer(FACT-B)was used to evaluate the score of quality of life before and after operation,and postoperative complications were also observed.Results In the control group and the observation group,the intraoperative blood loss was(82.61±12.38)ml,(88.76±13.57)ml,respectively;and drainage tube extubation time was(3.51±0.62)d and(3.64±0.58)d,respectively;there was no statistically significant difference between the two groups(t value was 1.864,0.853,respectively,all P>0.05).The operation time of the observation group was longer than that of the control group[(2.59±0.29)h vs.(1.72±0.32)h,t=11.217,P<0.001].The amount of drainage of the control group was higher than that of the observation group[(215.45±47.69)ml vs.(151.36±31.67)ml,t=6.233,P<0.001];the length of hospital stay of the control group was longer than that of the observation group[(14.51±2.32)d vs.(10.79±1.86)d,t=6.965,P<0.001].The excellent and good rate of postoperative breast appearance of the observation group was higher than that of the control group[96.77%(30/31)vs.74.19%(23/31),χ^(2)adjusted=4.679,P=0.031].There were no statistical differences in all items including healt

关 键 词：乳腺肿瘤 胸肌 筋膜 假体和植入物 乳房成形术 

分 类 号：R737.9[医药卫生—肿瘤]