脱细胞异体真皮基质辅助假体一期乳房重建能明显改善美容效果和生活质量:附68例乳腺癌患者一期乳房重建效果评估  

Acellular dermal matrix assisted one-stage breast reconstruction with prosthesis can significantly improve cosmetic effect and quality of life:Evaluation of immediate breast reconstruction in 68 patients with breast cancer

作　　者：赵烨 赵菁[1] 李开富[1] 王亚军[1] 康骅[1] ZHAO Ye;ZHAO Jing;LI Kaifu;WANG Yajun;KANG Hua(Center for Thyroid and Breast Surgery,Department of General Surgery of Xuanwu Hospital,Capital Medical University,Beijing 100053,P.R.China)

机构地区：[1]首都医科大学宣武医院普外科,甲状腺乳腺疾病诊疗中心,北京100053

出　　处：《中国普外基础与临床杂志》2022年第5期623-631,共9页Chinese Journal of Bases and Clinics In General Surgery

基　　金：北京乳腺病防治学会肿瘤防治科研项目(项目编号:2015-8-8)。

摘　　要：目的评价脱细胞异体真皮基质补片(acellular dermal matrix,ADM)在乳腺癌一期假体植入乳房重建中的应用效果。方法回顾性分析68例乳腺癌一期假体植入乳房重建患者的临床资料,根据乳房假体植入胸大肌后方间隙后是否使用ADM分为ADM组(43例)和非ADM组(25例),比较2组乳房假体大小、手术时间、术中出血量、引流时间、总引流量、住院时间、术后并发症、术后乳房美容效果及患者生存质量。结果2组患者的手术时间、总引流量、引流时间、住院时间、术后并发症及术中切除腺体体积方面比较差异均无统计学意义(P>0.05)。ADM组术中出血量少于非ADM组,假体体积大于非ADM组,假体与切除腺体体积差值小于非ADM组,其差异均有统计学意义(P<0.05)。重建外观方面ADM组患者的主观满意度及客观测量评分均优于非ADM组(P<0.05),尤其是在乳房对称性、手术瘢痕及乳头横向移位距离方面。术后生存质量方面ADM组患者在体像、性功能和性兴趣方面优于非ADM组(P<0.01)。结论对于乳腺癌患者,在保留乳头乳晕的乳房腺体切除后应用ADM辅助假体植入一期乳房重建安全可行。ADM作为胸大肌的延伸可扩大用于放置假体的胸大肌后间隙,使假体的选择更加从容。联合应用ADM可获得更理想的乳房外观,改善患者的术后生存质量及满意度。Objective To evaluate the application effect of acellular dermal matrix(ADM)in immediate breast reconstruction after mammary mastectomy with prosthetic implants.Methods The clinical data of 68 patients with breast cancer undergoing immediate breast reconstruction with prosthetic implantation in our hospital were retrospectively analyzed and divided into ADM group(n=43)and non-ADM group(n=25),according to the use of ADM in the posterior space of pectoralis major muscle while prosthesis implantation or not.The size of breast prosthesis,operative time,intraoperative blood loss,drainage duration,total drainage,total hospital stay,postoperative complications,postoperative cosmetic effect and quality of life of patients were compared between the two groups.Results Patients in the ADM group showed no statistically significant difference regarding operative time,drainage duration,total drainage,hospital stay,postoperative complications and intraoperative removed gland volume with the non-ADM group(P>0.05).The average intraoperative blood loss in the ADM group was less than that of the non-ADM group,the average volume of prosthesis in the ADM group was bigger than that of the non-ADM group,the volume difference between prosthesis and removed gland in the ADM group was smaller than that of the non-ADM group,which was considered statistically significant difference(P<0.05).The subjective satisfaction and objective measurement scores of patients in the ADM group were significantly better than those of the non-ADM group,especially in the symmetry of breast,surgical scar and distance of lateral displacement of nipple(P<0.05).The postoperative quality of life in the ADM group was significantly better than that of the non-ADM group in terms of body image,sexual function and sexual interest(P<0.01).Conclusions It is safe and feasible to use ADM-assisted the immediate breast reconstruction after nipplesparing mammary mastectomy with prosthetic implantation.As an extension of the pectoralis major muscle,ADM can enlarge the posterio

关 键 词：乳腺癌 一期乳房重建 假体植入 美容效果 脱细胞异体真皮基质 

分 类 号：R737.9[医药卫生—肿瘤]