腹壁下动脉穿支皮瓣乳房重建术后并发症对患者报告结局的影响
Postoperative complications after deep inferior epigastric perforator flap breast reconstruction and their impact on patient-reported outcomes
郭旭辉 1龚喜龙 1肖辉 1阳跃 2焦得闯 1张矫 1刘真真1
作者信息
- 1. 郑州大学附属肿瘤医院乳腺科 河南省肿瘤医院乳腺科 河南省乳腺癌诊疗中心,郑州 450008
- 2. 北京大学首钢医院修复重建外科,北京 100144
- 折叠
摘要
目的 探讨腹壁下动脉穿支皮瓣乳房重建术后并发症的影响因素,以及术后并发症是否会影响患者的生活质量.方法 回顾性分析郑州大学附属肿瘤医院乳腺科2019年12月至2023年3月行腹壁下动脉穿支皮瓣乳房重建手术患者的临床及随访资料.结果 85例行腹壁下动脉穿支皮瓣乳房重建的患者入组.其中 Ⅰ期重建71例,Ⅱ期重建14例.22例(25.9％)出现了术后并发症,11例(12.9％)出现了皮瓣并发症,11例(12.9％)出现了腹部供区并发症.单因素及多因素分析显示,总体并发症发生与高的BM1、早期开展的手术相关(P＜0.05),皮瓣并发症与高的BM1、早期开展的手术、术中采用内乳血管的分支作为受区血管有关(P＜0.05),而腹部并发症与既往腹部手术瘢痕相关(P＜0.05).BREAST-Q评分显示,与无手术并发症组相比,手术并发症组在乳房满意度、心理健康、躯体健康-胸部、躯体健康-腹部、对腹部的满意度、性健康等维度差异均无统计学意义(P＞0.05).结论 腹壁下动脉穿支皮瓣乳房重建存在明显的学习曲线,患者的临床特征(BM1、腹部切口瘢痕)以及术中受区血管的选择可能对患者术后的并发症产生影响,而术后并发症的出现并未对患者报告结局产生影响.
Abstract
Objective To investigate the factors that influence the occurrence of complications following deep inferior epigastric perforator(DIEP)flap breast reconstruction,and to determine whether these complications have an impact on the patient's quality of life.Methods The clinical and follow up data from patients who underwent DIEP flap breast reconstruction at the Department of Breast,Affiliated Cancer Hospital of Zhengzhou University from Dec 2019 to Mar 2023 were retrospectively analyzed.Results A total of 85 patients underwent DIEP flap breast reconstruction,including 71 stage Ⅰ reconstructions and 14 stage Ⅱ reconstructions.Postoperative complications occurred in 22 cases 25.9％,including flap complications in 11 cases(12.9％)and abdominal donor site complications in 11 cases(12.9％).Univariate and multivariate analyses showed that the overall incidence of complications was associated with high BMI and early surgery(P＜0.05).Flap complications were associated with high BMI,surgery performed at initial phase,and the use of internal mammary vascular branches as recipient vessels(P＜0.05).Abdominal complications were associated with previous abdominal surgery scars(P＜0.05).BREAST-Q scores showed no significant differences between the surgical complication group and the no complication group in terms of breast satisfaction,mental health,physical health-chest,physical health-abdomen,satisfaction with abdomen,sexual health,etc.(P＞0.05).Conclusions DIEP flap breast reconstruction has a significant learning curve.The patient's own clinical characteristics(such as BMI and abdominal incision scars)and intraoperative choices(such as the selection of recipient vessels)may influence the occurrence of postoperative complications.However,the presence of postoperative complications does not appear to have an impact on patient-reported outcomes.
关键词
乳腺肿瘤/腹部皮瓣/术后并发症/危险因素/患者报告结局Key words
Breast neoplasms/Abdominal flaps/Postoperative complications/Risk factors/Patient-reported outcomes引用本文复制引用
基金项目
河南省医学科技攻关计划(LHGJ20210179)
出版年
2024
NETL
NSTL
万方数据