早期乳腺癌同期行乳腺癌超象限切除术+背阔肌皮瓣转移乳房重建术近远期疗效观察
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摘要
目的观察早期乳腺癌患者同时行乳腺癌超象限切除术和背阔肌皮瓣转移乳房重建术近远期疗效。方法我院2010年1月—2011年12月早期乳腺癌患者46例,经患者知情同意后同期行乳腺癌超象限切除+背阔肌皮瓣转移乳房重建术,本组患者设为观察组;以TNM分期、年龄、腋窝淋巴结状态1∶1配对,选择同期行传统保乳术+术后放疗的46例早期乳腺癌患者作为对照组,比较两组近期疗效(术后乳房美容效果、术后并发症),远期疗效(随访至2016年12月,比较复发转移率、5年无病生存率和总生存率)。结果:观察组手术时间长于对照组,差异有统计学意义(P<0.05)。两组引流量、拔管时间、淋巴结清扫数差异均无统计学意义(P>0.05)。结果观察组手术时间长于对照组,差异有统计学意义(P<0.05)。两组引流量、拔管时间、淋巴结清扫数差异均无统计学意义(P>0.05)。观察组皮下积液发生率为36.96%,高于对照组的4.35%,差异有统计学意义(P<0.05)。观察组乳房优良率为69.57%,明显高于对照组的39.13%,差异有统计学意义(P<0.05)。观察组复发转移率为10.87%,5年无瘤生存、5年总生存为89.13%、93.48%,因乳腺癌死亡率为6.52%,对照组分别为10.87%、86.96%、93.48%和4.35%,差异均无统计学意义(P>0.05)。结论早期乳腺癌患者同期行乳腺癌超象限切除术和背阔肌皮瓣转移乳房重建术近远期疗效与保乳术相同,但乳房美容效果有明显提高。
Objective: To observe the curative effect of breast reconstruction in breast cancer patients. Methods: From January 2010—December 2011,46 patients with early breast cancer were selected,with the their informed consent during the same period after breast cancer super quadrant resection + back broadly myocutaneous flap transfer breast revascularization was conducted,and this group of patients as observation group; According to TNM staging,age,1∶ 1 paired axillary lymph node status,traditional confirmed breast surgery plus postoperative radiotherapy of 46 cases of early breast cancer patients were chosen as the control group,and the two groups were compared in the near future curative effect( postoperative breast cosmetic effect,complication),the long-term curative effect( followed up to December 2016,with recurrent metastatic rate,5),year disease-free survival and overall survival. Results: There was a statistical significance( P < 0. 05)for the observed group. There was no statistical significance( P > 0. 05) in lead flow,time of pulling,and lymph node cleaning of both groups. The incidence rate of subcutaneous effusion was 36. 96%,compared with 4. 35% in the control group,and the difference was statistically significant( P < 0. 05). The rate of optimal breast cancer was 69. 57%,which was significantly higher than the 39. 13% of the control group,and the difference was statistically significant( P < 0. 05).Observation group recurrence metastasis rate was 10. 87%,the five years of disease-free survival and overall survival were 89. 13% and 89. 13% for five years,and mortality was 6. 52% because of breast cancer,while those in the control group were 10. 87%,86. 96%,93. 48% and 10. 87% respectively,there were no statistically significant difference( P > 0. 05).Conclusion: Effect on the patients with early breast cancer in the same period of the breast cancer hyperquadrant resection plus the back of the broad muscle flap transfer of the breast reconstruction is the same as confirmed breast augmentation,but the breast cosmetic effect is improved obviously.
Objective: To observe the curative effect of breast reconstruction in breast cancer patients. Methods: From January 2010—December 2011,46 patients with early breast cancer were selected,with the their informed consent during the same period after breast cancer super quadrant resection + back broadly myocutaneous flap transfer breast revascularization was conducted,and this group of patients as observation group; According to TNM staging,age,1∶ 1 paired axillary lymph node status,traditional confirmed breast surgery plus postoperative radiotherapy of 46 cases of early breast cancer patients were chosen as the control group,and the two groups were compared in the near future curative effect( postoperative breast cosmetic effect,complication),the long-term curative effect( followed up to December 2016,with recurrent metastatic rate,5),year disease-free survival and overall survival. Results: There was a statistical significance( P < 0. 05)for the observed group. There was no statistical significance( P > 0. 05) in lead flow,time of pulling,and lymph node cleaning of both groups. The incidence rate of subcutaneous effusion was 36. 96%,compared with 4. 35% in the control group,and the difference was statistically significant( P < 0. 05). The rate of optimal breast cancer was 69. 57%,which was significantly higher than the 39. 13% of the control group,and the difference was statistically significant( P < 0. 05).Observation group recurrence metastasis rate was 10. 87%,the five years of disease-free survival and overall survival were 89. 13% and 89. 13% for five years,and mortality was 6. 52% because of breast cancer,while those in the control group were 10. 87%,86. 96%,93. 48% and 10. 87% respectively,there were no statistically significant difference( P > 0. 05).Conclusion: Effect on the patients with early breast cancer in the same period of the breast cancer hyperquadrant resection plus the back of the broad muscle flap transfer of the breast reconstruction is the same as confirmed breast augmentation,but the breast cosmetic effect is improved obviously.
引文
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[9]杜晓辉,李荣,徐文通,等.早期乳腺癌保乳手术加综合治疗的临床研究[J].解放军医学杂志,2006,31(5):478-479.
[10]刘学敏,顾瑞香,王海强,等.保留乳头乳晕复合体的乳腺癌术后即刻乳房重建术[J].中国美容整形外科杂志,2016,27(4):212-214.
[2]仉玮,吴彦岚,田焕,等.乳腺癌术后Ⅰ期假体植入乳房重建术42例临床分析[J].广东医学,2016,37(4):546-548.
[3]刘凤梅,龚柳燕,唐勇,等.乳腺癌改良根治术后自体背阔肌皮瓣乳房重建术后X线表现[J].放射学实践,2015,30(4):351-354.
[4]曹璐,陈佳艺.浸润性乳腺癌乳房切除术联合Ⅰ期重建后放疗相关问题研究现状[J].中华放射肿瘤学杂志,2016,25(10):1125-1129.
[5]曹一鸣,韦长元,莫军扬,等.乳腺癌乳房重建术临床疗效及相关因素分析[J].中华普通外科杂志,2016,31(2):126-129.
[6]王宇,李新宇,张开通,等.背阔肌肌皮瓣乳房重建术供区高负压引流的应用探讨[J].中国医刊,2012,47(9):53-54.
[7]Richard MR.Surgery insight:oncoplastic breast-conserving reconstruction-indications,benefits,choices and outcomes[J].Natur Clin Pract Oncol,2007,4(11):657-664.
[8]王文静,刘永瑞,崔小松,等.乳腺外科手术患者切口感染危险因素的调查[J].中华医院感染学杂志,2016,26(12):2779-2781.
[9]杜晓辉,李荣,徐文通,等.早期乳腺癌保乳手术加综合治疗的临床研究[J].解放军医学杂志,2006,31(5):478-479.
[10]刘学敏,顾瑞香,王海强,等.保留乳头乳晕复合体的乳腺癌术后即刻乳房重建术[J].中国美容整形外科杂志,2016,27(4):212-214.