摘要
目的 探讨自体组织乳房重建术与保乳整形术后乳腺癌患者生存及复发、转移情况以及乳房重建满意度差异.方法 回顾性病例系列分析及队列研究.回顾性分析2018年1月至2021年12月山西省肿瘤医院收治的144例乳腺癌患者临床资料.根据手术方式分为保乳整形组(行保乳整形术)和乳房重建组[行自体组织乳房重建术(横行腹直肌肌皮瓣)],比较干预效果、BREAST-Q量表评分和乳房美学效果.随访1年,记录患者生存、局部复发、远处转移情况.结果 保乳整形组患者72例,年龄(45±1)岁;乳房重建组患者72例,年龄(45±2)岁.乳房重建组和保乳整形组患者术后1年均生存,局部复发率[1.39％(1/72)比 2.78％(2/72),x2=0.34,P=0.560]、远处转移率[1.39％(1/72)比 1.39％(1/72),x2=0.00,P=1.000]差异均无统计学意义.乳房重建组BREAST-Q量表乳房满意度评分高于保乳整形组[(87±6)分比(67±5)分],差异有统计学意义(t=14.33,P＜0.001);两组社会心理健康、性健康、胸部生理健康、放疗不良影响评分差异均无统计学意义(均P＞0.05).乳房重建组乳房美学效果优良率高于保乳整形组[95.83％(69/72)比69.44％(50/72)],差异有统计学意义(x2=17.47,P＜0.001).结论 乳腺癌患者自体组织乳房重建术与保乳整形术后生存及复发、转移情况相近,在社会心理健康、性健康、胸部生理健康、放疗不良影响方面亦未显示出差异,但自体组织乳房重建术乳房美学效果更佳,且患者对乳房满意度更高.
Abstract
Objective To investigate the differences in survival,recurrence,metastasis and breast reconstruction satisfaction between autologous tissue breast reconstruction and breast-conserving plastic surgery in breast cancer patients.Methods A retrospective case series analysis and cohort study was conducted.Clinical data of 144 breast cancer patients in Shanxi Province Cancer Hospital from January 2018 to December 2021 were retrospectively analyzed.The patients were divided into breast-conserving plastic surgery group(treated with breast-conserving plastic surgery)and breast reconstruction group[treated with autologous tissue breast reconstruction(transverse rectus abdominis musculocutaneous flap)]according to the surgical methods,and the intervention effect,BREAST-Q scale score and breast aesthetic effect were compared.The patients were followed-up for 1 year,and their survival,local vecurrence and distant metastasis status were recorded.Results There were 72 patients in the breast-conserving plastic surgery group,aged(45±1)years old,and 72 patients in the breast reconstruction group,aged(45±2)years old.Patients in the breast reconstruction group and breast-conserving plastic surgery group survived 1 year after surgery,and the differences in local recurrence rate[1.39％(1/72)vs.2.78％(2/72),x2=0.34,P=0.560]and distant metastasis rate[1.39％(1/72)vs.1.39％(1/72),x2=0.00,P=1.000]were not statistically significant.The BREAST-Q scale breast satisfaction score in the breast reconstruction group was higher than that in the breast-conserving plastic surgery group[(87±6)points vs.(67±5)points],and the difference was statistically significant(t=14.33,P＜0.001);the differences in scores of psychosocial health,sexual health,physical health of the chest,and the adverse effects of radiotherapy between the two groups were not statistically significant(all P＞0.05).The rate of excellent and good aesthetic outcomes for the breast in the breast reconstruction group was higher than that in the breast-conserving plastic surgery group[95.83％(69/72)vs.69.44％(50/72)],and the difference was statistically significant(x2=17.47,P＜0.001).Conclusions The survival,recurrence and metastasis in breast cancer patients with autologous tissue breast reconstruction and breast-conserving plastic surgery are similar,and there are no differences in psychosocial health,sexual health,physical health of the chest and the adverse effects of radiotherapy,but breast aesthetic effect of autologous tissue breast reconstruction is better,and the patients are more satisfied with their breasts.
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