摘要
目的初步探讨合成补片联合前锯肌脂肪筋膜瓣乳房假体植入术在早期乳腺癌即刻乳房重建术中的研究,并对术后并发症的发生、术后乳房外形以及患者满意度等方面进行分析,为早期乳腺癌进行即刻假体重建术的患者提供更多手术方式的选择。方法回顾性分析2015年1月-2022年1月南京医科大学附属常州第二人民医院乳腺外科61例接受保留乳头乳晕复合体的乳房切除术后即刻行乳房假体植入术的早期乳腺癌患者临床资料,根据前锯肌脂肪筋膜瓣与TiLoop补片在手术中应用情况分为3组:补片组(合成补片假体植入组22例),筋膜组(前锯肌脂肪筋膜瓣假体植入术18例)和联合组(合成补片联合前锯肌脂肪筋膜瓣假体植入术21例),比较3组患者手术时间、术后24 h疼痛评分、术后疼痛持续时间、术后引流管放置时间、术后并发症发生率、术后外形和患者满意度评分,评价应用不同手术方式的效果。结果补片组、筋膜组与联合组患者在手术时间及术后并发症发生率方面差异无统计学意义(P>0.05)。3组患者在术后24 h疼痛等级方面差异无明显统计学意义(P>0.05),但联合组与筋膜组术后疼痛持续时间均小于补片组(P<0.05)。补片组在引流管放置时间上长于联合组与筋膜组,差异有统计学意义(P<0.05)。术后一年随访分析发现:补片组与联合组Harris术后美容评分优于筋膜组(P<0.05)。Breast-Q乳房重建相关量表结果显示:3组患者对乳腺外科医生满意度、护理人员满意度及其他医生满意度评分均较高,但差异无统计学意义(P>0.05),而联合组与补片组乳房外形满意度评分高于筋膜组,差异有统计学意义(P<0.05)。结论保留乳头乳晕复合体的全乳切除术后即刻行TiLoop补片联合前锯肌脂肪筋膜瓣乳房假体植入术对于早期乳腺癌患者来说是安全可靠的。联合组引流管放置时间及术后疼痛持续时间均小于补片组,术后外形及乳房满意度均优于筋膜组,手术时间、术后疼痛评分及术后并发症发生率相较于筋膜组及补片组并未增加,是一种值得推广的手术方式。
Objective To investigate the application of titanium mesh(TiLoop Bra)combined with serratus anterior fat fascia flap in immediate prosthetic breast reconstruction for early breast cancer.Methods The clinical data of 61 patients with early breast cancer who underwent prosthesis breast reconstruction after nipple sparing mastectomy(NSM),from January 2015 to January 2022 in the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University were retrospectively analyzed.The patients were divided into 3 groups according to the application of Serratus Anterior Fascia Flap and TiLoop Bra in reconstruction:titanium mesh group(22 cases of using TiLoop Bra),fascia group(18 cases of using anterior serratus fat fascia flap)and combined group(21 cases of using TiLoop Bra combined with anterior serratus fat fascia flap).The operation time,postoperative pain score,postoperative pain duration,drainage tube placement time,incidence of complications,postoperative appearance and patient BREAST-Q questionnaire were compared among the three groups.Results There were no significant differences in operation time,postoperative pain score and incidence of postoperative complications among titanium mesh group,fascia group and combined group(P>0.05).There was no significant difference in postoperative pain score after 24 h among the 3 groups(P>0.05),but the postoperative pain duration in the combined group and fascia group was lower than that in the titanium mesh group(P<0.05).The average drainage tube placement time in titanium mesh group was longer than that in combined group and fascia group,the differences were statistically significant(P<0.05).The one-year follow-up analysis showed that the postoperative appearance scores of the titanium mesh group and the combined group were better than that of the fascia group(P<0.05).According to the scores of the Breast-Q questionnaire related to breast reconstruction,patients in the 3 groups all had high satisfaction level of breast surgeons,nurses and other doctors,but there was no statistical difference(P>0.05),while the combined group and the titanium mesh group had higher scores on the satisfaction level of breast than the fascia group,with statistical significance(P<0.05).Conclusion TiLoop Bra combined with serrate anterior fascia flap prosthesis implantation breast reconstruction after NSM is safe and reliable for early breast cancer patients.The combined group is superior to the titanium mesh group in drainage tube placement time and postoperative pain duration.It is better than fascia group in postoperative appearance and patient BREAST-Q questionnaire score.Compared with the other two groups,there is no increase in operation time,postoperative pain score and incidence of complications rate.It's a procedure worth promoting.
作者
王战
许凌云
赵彤
王先兰
何潇
WANG Zhan;XU Lingyun;ZHAO Tong;WANG Xianlan;HE Xiao(Dalian Medical University,Dalian,Liaoning 116000,China;Department of Breast Surgery,the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University,Changzhou,Jiangsu 213000,China)
出处
《手术电子杂志》
2023年第3期51-56,共6页
Electronic Journal of Medical Operations
作者简介
通讯作者:许凌云,Email:xulingyun1490@163.com
