不同时间行背阔肌皮瓣乳房重建术对乳腺癌患者的结局影响  

The effect of latissimus dorsi reconstruction at different times on the outcome of breast cancer cases

作　　者：陈卫伶 武彦萍 穆凌光 CHEN Wei-ling;WU Yan-ping;MU Ling-guang(Department of Head,Neck and Breast Surgery,the First Affiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China)

机构地区：[1]邢台医学高等专科学校第一附属医院头颈乳腺外科,邢台054000

出　　处：《东南国防医药》2022年第4期362-366,共5页Military Medical Journal of Southeast China

基　　金：邢台市科技计划项目(2019ZC238)。

摘　　要：目的探究不同时间段行背阔肌皮瓣乳房重建术对乳腺癌手术治疗患者的结局影响。方法选取2016年1月1日至2018年12月31日于邢台医学高等专科学校第一附属医院甲乳外科行乳腺癌手术背阔肌皮瓣乳房重建治疗的患者85例,根据乳房重建的时间分为组(重建后放疗)58例及组(放疗后重建)27例,比较2组患者并发症的发生率、美学评分、术后BREAST-Q评分及生活质量评分,同时比较二期组患者术前及等待期间患者的主观幸福感、身体心像及性健康评分,并采用logistic分析患者选择重建时间的影响因素。结果一期组患者并发症发生率较组高,但差异无统计学意义(P>0.05);而美学评分、术后BREAST-Q评分及生活质量评分较术前均提高,但组间差异无统计学意义(P>0.05);与术前比较,二期组患者等待期间的主观幸福感[(66.77±2.97)分vs(61.24±2.40)分]、身体心像[(9.01±2.18)分vs(8.12±1.92)分]及性健康评分[(31.09±3.33)分vs(28.17±3.28)分]明显降低(均P<0.05);同时logistic分析显示年龄<45周岁、存在经济压力、高中及以上学历以及居住地城市均是患者选择二期重建的影响因素。结论同期行背阔肌皮瓣乳房重建并未增加并发症发生率,同时不同时间段对患者术后的美学评分、术后BREAST-Q评分及生活质量评分无影响;而重建则会降低患者的主观幸福感、身体心像及性健康评分,同时logistic分析显示患者选择重建时间与多因素相关,可见乳腺癌术后背阔肌皮瓣重建应从患者特征出发,选择个性化的重建时机。Objective To investigate the effect of breast reconstruction with latissimus dorsi musculocutaneous flap on breast cancer patients with operation treatment at different time periods.Methods The clinical data of 58 patients who underwent breast cancer surgery with latissimus dorsi flap breast reconstruction in the First Affiliated Hospital of Xingtai Medical College from January 1,2016 to December 31,2018 were prospectively analyzed.According to the time of breast reconstruction,they were divided into a first-stage group(58 cases after reconstruction and radiotherapy)and a second-stage(after radiotherapy)reconstruction group(27 cases).The incidence of adverse reactions,aesthetic scores,postoperative BREAST-Q score and quality of life score,and the subjective well-being,body image and sexual health scores of patients in the two-stage reconstruction group before and during the waiting period were compared,and the influencing factors of patients′choice of reconstruction time were analyzed by logistic regression.Results The incidence of adverse reactions in the first-stage reconstruction group was higher than that in the second-stage reconstruction group,but the difference was not statistically significant(P>0.05).The patients′subjective well-being[(66.77±2.97)vs(61.24±2.40)],body-mind image[(9.01±2.18)vs(8.12±1.92)]and sexual health score during the waiting period of the patients in the two-stage reconstruction group[(31.09±3.33)vs(28.17±3.28)]was significantly weaker than preoperative(all P<0.05).At the same time,logistic analysis showed that age<45 years old,financial pressure,high school education or above,and city of residence were all patients’choice for the second stage reconstruction factors.Conclusion Breast reconstruction of the latissimus dorsi flap in the same period does not increase the adverse reaction rate.There is no effect on the postoperative aesthetic score,postoperative BREAST-Q score and quality of life score of the patient,while the second-stage reconstruction will increase the patie

关 键 词：乳腺癌手术 背阔肌皮瓣重建 结局 生活质量 个性化选择 

分 类 号：R737.9[医药卫生—肿瘤]