改良根除术联合自体植皮术在乳腺癌手术中的应用价值
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摘要
目的探讨乳腺癌改良根治术及自体植皮的实际应用价值,为临床乳腺癌治疗提供一些思路。方法随机将40例乳腺癌女性患者分为对照组和治疗组,对照组仅行乳腺癌改良根治术,治疗组在改良根治术的同时行自体腹部皮肤移植,对所有皮瓣坏死的患者行二次植皮,观察植皮在乳腺癌术后的临床应用。结果对照组患者发生皮瓣坏死的有8例,占对照组40%,而治疗组患者发生皮瓣坏死的仅有2例,占治疗组10%,两者相比具有显著差异统计学意义(P<0.05)。观察组和治疗组在手术时间长短上无明显差异(P>0.05),但住院时间治疗组明显短于观察组,差异具有统计学意义(P<0.05),观察皮瓣坏死后二次植皮对患者的影响,发现对照组明显二次植皮例数多于治疗组,差异具有统计学意义(P<0.05)。两组患者均进行5~8年的随访观察,评价植皮对患者的影响,两组在肿瘤复发上没有明显差异(P>0.05),但皮下积液和皮瓣坏死等术后不良反应发生率对照组明显高于治疗组,差异具有统计学意义(P<0.05)。结论乳腺癌患者行改良根治术后同时行自体植皮手术,对患者的手术时间、降低患者的费用以及远期临床效果都较好,且不会增加患者的肿瘤复发,值得临床推广应用。
Objective To discuss the value of modified radical mastectomy and postoperative autologous skin grafting application,and to provide some ideas for the clinical treatment of breast cancer. Methods 40 women with breast cancer were randomly divided into the control group and the treatment group,the control group received modified radical mastectomy of breast cancer,the treatment group received modified radical mastectomy combined with autologous abdominal skin transplantation. For all the flap necrosis patients who underwent the second skin grafts,the clinical application of skin grafting in the breast cancer after improvement eradication surgery were observed. Results The incidence of flap necrosis in patients in the control group was 8 cases,accounting for 40% of the control group,while the incidence of flap necrosis in patients in the treatment group was only 2 cases,accounting for 10% in the treatment group,it had statistical significance difference between the 2 groups( P < 0. 05). There had significant difference in the operation time between the 2 groups( P > 0. 05),but the treatment group was significantly shorter than that the observation group in the hospitalization stay,there had significant difference( P < 0. 05),the influence of flap necrosis in patients was observed,the number of the second skin grafts in the control group was obviously higher in the treatment group,there had significant difference( P < 0. 05). 5 ~ 8 year follow-up of the 2 groups showed that on the impact of skin grafting in patients,there had no significant difference in tumor recurrence( P > 0. 05),but in the subcutaneous hydrops and skin flap necrosis after operation of adverse reactions in the treatment group was significantly lower than that of the control group,there had significant difference( P < 0. 05). Conclusion Modified radical mastectomy and autologous skin grafting operation for breast cancer can reduce the operation time,costs of operation and has better long-term clinical efficacy,and it does not increase the tumor recurrence,it is worthy of clinical application.
Objective To discuss the value of modified radical mastectomy and postoperative autologous skin grafting application,and to provide some ideas for the clinical treatment of breast cancer. Methods 40 women with breast cancer were randomly divided into the control group and the treatment group,the control group received modified radical mastectomy of breast cancer,the treatment group received modified radical mastectomy combined with autologous abdominal skin transplantation. For all the flap necrosis patients who underwent the second skin grafts,the clinical application of skin grafting in the breast cancer after improvement eradication surgery were observed. Results The incidence of flap necrosis in patients in the control group was 8 cases,accounting for 40% of the control group,while the incidence of flap necrosis in patients in the treatment group was only 2 cases,accounting for 10% in the treatment group,it had statistical significance difference between the 2 groups( P < 0. 05). There had significant difference in the operation time between the 2 groups( P > 0. 05),but the treatment group was significantly shorter than that the observation group in the hospitalization stay,there had significant difference( P < 0. 05),the influence of flap necrosis in patients was observed,the number of the second skin grafts in the control group was obviously higher in the treatment group,there had significant difference( P < 0. 05). 5 ~ 8 year follow-up of the 2 groups showed that on the impact of skin grafting in patients,there had no significant difference in tumor recurrence( P > 0. 05),but in the subcutaneous hydrops and skin flap necrosis after operation of adverse reactions in the treatment group was significantly lower than that of the control group,there had significant difference( P < 0. 05). Conclusion Modified radical mastectomy and autologous skin grafting operation for breast cancer can reduce the operation time,costs of operation and has better long-term clinical efficacy,and it does not increase the tumor recurrence,it is worthy of clinical application.
引文
[1]赵凯华,胡亦钦,俞乔,等.乳腺癌术后皮下积液的影响因素探讨〔J〕.中国肿瘤外科杂志,2011,3(1):17-19.
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[5]卓睿,凌文津,石雪枫,等.乳腺癌术后即时扩展型背阔肌肌皮瓣乳房重建27例分析〔J〕.中华乳腺病杂志,2009,3(3):280-286.
[6]倪进斌,贾兴胜,谢芳,等.标本皮肤移植预防乳腺癌手术皮瓣坏死临床研究〔J〕.安徽医药,2014,18(5):912-914.
[7]王亚兵,陈剑平,陈斌.扩大背阔肌肌皮瓣在乳腺癌改良根治术后一期乳房再造中的应用〔J〕.中国普外基础与临床杂志,2010,17(7):735-738.
[8]张敏敏,莫军扬,覃舒婷.乳腺癌改良根治术后即刻背阔肌肌皮瓣移植重建乳房:42例分析〔J〕.中国组织工程研究,2014,18(36):5899-5904.
[9]Romics L Jr,Chew BK,Weiler-Mithoff E,et al.Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction〔J〕.Br J Surg,2012,99(6):799-806.
[10]穆兰花,辛敏强,栾杰.乳腺癌术后乳房重建的研究现状及其评价〔J〕.中华乳腺病杂志,2011,5(2):215-221.
[2]张明府.乳腺癌改良根治术后皮瓣坏死的预防与治疗〔J〕.中国肿瘤外科杂志,2011,3(3):182-183.
[3]吴兴荣,杨顺江,徐朝辉,等.自体皮移植在乳腺癌手术中的应用〔J〕.中国中西医结合外科杂志,2010,16(2):225-226.
[4]王雅辉,杨希恩.乳腺癌根治术后皮瓣坏死危险因素分析及对策〔J〕.吉林医学,2013,34(17):3430-3431.
[5]卓睿,凌文津,石雪枫,等.乳腺癌术后即时扩展型背阔肌肌皮瓣乳房重建27例分析〔J〕.中华乳腺病杂志,2009,3(3):280-286.
[6]倪进斌,贾兴胜,谢芳,等.标本皮肤移植预防乳腺癌手术皮瓣坏死临床研究〔J〕.安徽医药,2014,18(5):912-914.
[7]王亚兵,陈剑平,陈斌.扩大背阔肌肌皮瓣在乳腺癌改良根治术后一期乳房再造中的应用〔J〕.中国普外基础与临床杂志,2010,17(7):735-738.
[8]张敏敏,莫军扬,覃舒婷.乳腺癌改良根治术后即刻背阔肌肌皮瓣移植重建乳房:42例分析〔J〕.中国组织工程研究,2014,18(36):5899-5904.
[9]Romics L Jr,Chew BK,Weiler-Mithoff E,et al.Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction〔J〕.Br J Surg,2012,99(6):799-806.
[10]穆兰花,辛敏强,栾杰.乳腺癌术后乳房重建的研究现状及其评价〔J〕.中华乳腺病杂志,2011,5(2):215-221.