牛心包补片联合假体植入一期乳房再造术141例临床分析  

Application of acellular bovine pericardium patch in implant based immediate breast reconstruction

作　　者：丁泊文 王慧清 何珊珊 王庶 黄清丰 韩春勇 刘静 殷竹鸣 孙敬岩 王燕 尹健 Ding Bowen;Wang Huiqing;He Shanshan;Wang Shu;Huang Qingfeng;Han Chunyong;Liu Jing;Yin Zhuming;Sun Jingyan;Wang Yan;Yin Jian(Department of Breast Reconstruction and Oncoplastic Surgery,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin,Tianjin′s Clinical Research Center for Cancer,Key Laboratory of Breast Cancer Prevention and Therapy,Tianjin Medical University,Ministry of Education,Sino-Russian Joint Research Center for Oncoplastic Breast Surgery,Tianjin Medical University Cancer Institute&Hospital,Tianjin 300060,China)

机构地区：[1]国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市恶性肿瘤临床医学研究中心,乳腺癌防治教育部重点实验室,中俄乳腺肿瘤整形联合研究中心,天津医科大学肿瘤医院乳房再造科,天津300060

出　　处：《中华外科杂志》2022年第3期237-243,共7页Chinese Journal of Surgery

基　　金：天津市“一带一路”科技计划项目(18PTZWHZ00050);天津市“项目+团队”重点培养专项基金(XB202008)。

摘　　要：目的:探讨应用牛心包补片联合假体植入行一期乳房再造术的临床效果。方法:回顾性分析2016年6月至2019年10月141例在天津医科大学肿瘤医院乳房再造科接受牛心包补片联合假体植入一期乳房再造术患者的临床资料。患者均为女性,年龄(38.8±8.5)岁(范围:13~60岁),体重指数(21.9±2.5)kg/m^(2)(范围:16.0~32.3 kg/m^(2)),均由病理学检查确诊为乳腺癌,其中原位癌39例,Ⅰ期46例,Ⅱ期40例,Ⅲ期16例。患者接受保留乳头乳晕或保留皮肤的全乳切除术联合前哨淋巴结活检或腋下淋巴结清扫,并应用牛心包补片于胸肌后行假体植入。采用t检验、χ^(2)检验、Fisher确切概率法、Logistic回归分析临床病理学资料与并发症的关系,记录患者术前术后外观和生活质量评分。结果:患者手术时间[M(IQR)]为3.6(1.5)h(范围:3.0~6.5 h)。术后近期并发症发生率为22.0%(31/141),主要为假体取出20例,其中15例发生在前30例手术患者。随访时间为28(8)个月(范围:20~53个月),术后远期并发症主要为包膜挛缩[11.2%(14/125)]和假体移位[10.4%(13/125)]。多因素分析结果显示,假体体积≥300 ml(OR=8.173,95%CI:1.302~51.315,P=0.021)和环乳晕切口(OR=7.809,95%CI:2.162~28.211,P<0.01)是患者发生术后近期局部并发症的独立影响因素。术后2年Breast-Q量表评分乳房外形满意度为(71.7±15.5)分,术后效果满意度为(90.4±9.5)分,心理满意度为(90.7±17.1)分,性生活满意度为(70.1±25.1)分。出院前满意率为95.4%(134/141),术后2年17.6%(22/125)的患者有修整意愿。结论:假体体积≥300 ml和环乳晕切口是牛心包乳房补片联合假体植入一期乳房再造术后近期局部并发症的独立影响因素。完成学习曲线后,该术式的术后并发症发生率较低,手术时间短,美容效果和患者术后生活质量较高。Objective To examine the clinical effect of acellular bovine pericardium patch in implant based immediate breast reconstruction.Methods The clinicopathological information of 141 breast cancer patients,who admitted to Department of Breast Reconstruction and Oncoplastic Surgery,Tianjin Medical University Cancer Hospital,underwent immediate mammoplasty with implants combined with acellular bovine pericardium patches were analyzed from June 2016 to October 2019.All patients were female,with the age of(38.8±8.5)years(range:13 to 60 years).The body mass index was(21.9±2.5)kg/m^(2)(range:16.0 to 32.3 kg/m^(2)).There were 39 cases of duct carcinoma in situ,46 cases of stageⅠ,40 cases of stageⅡand 16 cases of stageⅢ.All patients received nipple-areola-sparing mastectomy or skin-sparing mastectomy with sentinel lymph node biopsy or axillary lymph node dissection,and prosthesis implantation with sub-pectoralis combined with breast patch.The correlation of clinicopathological characters and complications was assessed by t test,χ^(2) test,Fisher′s exact probability method and Logistic regression.Pre-and post-operative aesthetic,quality of life scores were recorded.Results The operation time(M(IQR))was 3.6(1.5)hours(range:3.0 to 6.5 hours).The early postoperative complication rate was 22.0%(31/141),prosthesis removal was the main postoperative complication,accounting for 64.5%(20/31)of the total complications,of which 15 cases occurred in the first 30 patients.The follow-up time was 28(8)months(range:20 to 53 months),The most frequent long-term complications were capsular contracture and implant displacement,with the incidence of 11.2%(14/125)and 10.4%(13/125),respectively.Multivariate analysis showed that prosthesis volume≥300 ml(OR=8.173,95%CI:1.302 to 51.315,P=0.021)and peri-areolar incision(OR=7.809,95%CI:2.162 to 28.211,P<0.01)were independent relative factors for the occurrence of short-term postoperative local complications.After 2 years of operation,the score of breast appearance satisfaction was 71.7±15

关 键 词：乳腺肿瘤 乳房成形术 牛心包补片 手术后并发症 

分 类 号：R737.9[医药卫生—肿瘤]