摘要
目的分析一步法和二步法乳房重建手术对患者报告结局及并发症的影响。方法选取2017年3月至2022年3月98例乳房全切术后即刻乳房重建患者的临床资料,根据重建方式不同分为两组,一步法组50例行即刻假体植入乳房重建手术,二步法组48例行即刻扩张器-延迟假体植入乳房重建手术。SPSS 21.0软件完成数据分析,计数资料比较行χ^(2)检验或Fisher精确检验;计量资料用(±s)表示,组间比较行t检验;采用线性混合效应回归模型对术后并发症和患者报告结局进行多因素回归分析。P<0.05为差异有统计学意义。结果一步法组血清肿、切口愈合不良发生率高于二步法组,包膜挛缩发生率低于二步法组(P<0.05);一步法组Clavien-Dindo分级Ⅲ级例数多于二步法组(P<0.05);一步法组患者术后社会心理健康、乳房满意度及手术结果满意度等水平均低于二步法组(P<0.05)。线性混合效应回归模型分析结果显示:切口愈合不良与手术方法和使用补片有关(P=0.043、0.033);包膜挛缩及血清肿的发生分别与放疗和补片的使用有关(P=0.041、0.036);患者社会心理健康、乳房满意度与手术方法有关(P=0.024、0.001);手术结果满意度与术后放疗和淋巴结状态有关(P=0.017、0.039)。结论相比一步法乳房重建,二步法可降低切口愈合不良的发生比,并发症分级低,在提高患者术后社会心理满意度和乳房满意度方面更具优势。
Objective To analyze the effects of one-and two-step breast reconstruction on patient reported outcomes and complications.Methods A total of 98 patients who underwent immediate breast reconstruction after total mastectomy from March 2017 to March 2022 were selected and divided into two groups according to different reconstruction methods:the one-step group received 50 cases of immediate prosthesis implantation reconstruction surgery,and the two-step group received 48 cases of immediate dilator-delayed prosthesis implantation reconstruction surgery.SPSS 21.0 software was used to analyze the data,and the count data were compared by lineχ^(2) test or Fisher exact test.Measurement data were represented by(±s),and t test was performed for comparison between groups.Multivariate regression analysis of postoperative complications and patient-reported outcomes was performed using linear mixed effects regression model.P<0.05 was considered statistically significant.Results The incidence of seroma and poor wound healing in one-step group was higher than that in two-step group,and the incidence of capsular contracture was lower than that in two-step group(P<0.05).The number of Clavien-Dindo gradeⅢcases in one-step group was higher than that in two-step group(P<0.05).The levels of postoperative social mental health,breast satisfaction and surgical outcome satisfaction in one-step group were lower than those in two-step group(P<0.05).The results of linear mixed effects regression model showed that the poor wound healing was related to the surgical method and the use of mesh(P=0.043,0.033).Capsular contracture and seroma were related to radiotherapy and mesh use(P=0.041,0.036).Social psychological health and breast satisfaction were correlated with surgical methods(P=0.024,0.001).The satisfaction of surgical outcome was related to postoperative radiotherapy and lymph node status(P=0.017,0.039).Conclusions Compared with one-step breast reconstruction,two-step method can reduce the incidence of poor incision healing,lower complication grade,and has more advantages in improving patients'postoperative social psychological satisfaction and breast satisfaction.
作者
范拥国
吕勇刚
杨晓民
王虎霞
陈楠
贺赛
侯艳妮
赵静
张静远
韩丕华
Fan Yongguo;Lyu Yonggang;Yang Xiaomin;Wang Huxia;Chen Nan;He Sai;Hou Yanni;Zhao Jing;Zhang Jingyuan;Han Pihua(Department of Breast Oncology,Shaanxi Provincal Cancer Hospital,Xi’an 710061,China;Xi’an Third Hospital,Xi’an Shaanxi Province 710021,China)
出处
《中华普外科手术学杂志（电子版）》
2023年第3期262-266,共5页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
西安市卫生科研人才二类项目(J201902045)。
关键词
乳房重建
假体植入
扩张器
手术后并发症
患者报告结局评价
Breast Reconstruction
Prosthesis Implantation
Expander
Postoperative Complications
Patient Reported Outcome Measures
作者简介
通信作者:韩丕华,Email:m13310979756@163.com。
