【作者】 李巍；

【导师】 穆兰花；

【作者基本信息】 中国协和医科大学 ， 整形外科， 2007， 硕士

【摘要】 研究背景：本项工作是在中国临床肿瘤学科学基金(CSCO-康莱特基金)的资助下，我院与中国医学科学院肿瘤医院等十家单位共同合作完成。2003．1-2007．3，共行即刻乳房修复重建34例。这项研究的目的是对即刻乳房重建结果进行全面评价，为我国在即刻乳房重建领域的研究提供有力的指导依据。研究方法：我们参考国际公认的欧洲研究治疗癌症组织制定的癌症患者生活质量问卷调查条例(EORTC QLQ-C30)，及专为乳腺癌患者设计的生活质量随访表，包括乳腺癌化疗随访表和乳腺癌治疗功能评价(FACT-B)，通过与乳房重建专业人员的讨论和乳腺癌患者的广泛交流，结合我们的研究方向自行设计随访问卷调查表。随机选取同期40例延迟乳房重建的患者做对照组。本研究通过问卷和电话两种形式进行随访。随访内容包括：对重建结果的评价、生活质量问卷、心理影响、选择乳房重建的原因、乳房重建信息来源等方面。另外，我们用Hopwood等设计的体像评分表又对即刻乳房重建的患者进行问卷调查，进一步证实评价结果的科学性。研究结果：4年共行即刻乳房修复重建34例，延迟乳房重建共64例，即刻组随访了21例，随访比率为61.76％，延迟组随访了40例，随访比率为62.5％。采用SPSS11.5软件包对数据进行统计分析处理，对于有序的分类变量采用了Wilcoxon秩和检验，对于无序的分类变量采用了卡方检验。分析手术时间与手术费用时，以手术方式为区组，采用了随机区组设计的方差分析。分析年龄因素采用成组t检验。分析手术方法分类与并发症、再造乳房接受程度的关系采用Fisher确切概率法。分析选择乳房重建原因采用的是单因素和多因素Logistic逐步回归分析方法。1．两组对重建结果的评价没有统计学差别(P＞0.05)；即刻组满意度为85.7％，延迟组为92.5％；2．生活质量的影响：2．1两组在穿衣服方面没有统计学差异，但是即刻组有66.66％的人不受任何影响，延迟组仍然有32.5％的人不能穿暴露的衣服；2．2患者重建乳房后对参加社会活动的影响，即刻组明显有优势，P＜0.05；2．3两组在性生活方面没有统计学差异，即刻组性生活不受影响占52.38％，丈夫对重建乳房的满意率达61.9％；3．心理影响：3．1即刻组中有66.67％自信心不受影响；手术乳房重建后延迟组较即刻组的自信心明显增强(P＜0.05)；3．2即刻组有52.38％认为重建的乳房是自体乳房，有47.62％认为手术结果到达预期期望值，如果重新选择有80.95％仍然会选择相同的外科治疗方法；3．3即刻组表现出对癌症复发的担忧为42.86％；4．在乳房重建信息来源方面两组表现出很大差异，即刻组主要来源于肿瘤医生，延迟组主要来源于网络、电视节目的宣传(P＜0.05)；5．即刻组选择乳房重建的原因，主要是“不能接受失去乳房的心理障碍”和“恢复完整的身体”；6．其它结果：1)无论是即刻组还是延迟组，患者更愿意将背阔肌重建的乳房看成自己的乳房；2)即刻组更愿意选择相对简单的手术方式；3)手术并发症及瘢痕直接影响患者对重建结果的满意度；4)即刻组在花费和手术时间上均明显少于延迟组(F=15.462，P＜0.01；F=10.25，P＜0.01)；7．体像评分发现，对重建的乳房越满意体像评分越低。研究结论：1．早期乳腺癌行即刻乳房重建可以预防乳房切除后对患者心理和生活质量的影响。2．即刻乳房修复重建术不仅常规用于早期乳腺癌的乳房再造，而且可以用于晚期乳腺癌及复发肿瘤大范围切除的创面修复。3．即刻乳房重建的患者对结果要求更高。如果肿瘤情况允许，行SSM和保留NAC的乳腺癌改良根治术即刻乳房重建，效果较其它方法更理想，患者对重建乳房的满意度更具优势。因此，肿瘤科医生和整形外科医生的共同努力是提高患者的术后满意率的关键。更多还原

【Abstract】 The clinical assessment of immediatebreast reconstructionBackground: We cooperated with Chinese academy of medical scienceoncology hospital and others center in promoting the immediate breastreconstruction from January of 2003 to March of 2007, with staking ofChinese Society ClinicalOnconlogy(CSCO) fund. During this period, 34cases were performed and evaluated to supply information for furtherclinical work.Methods: Thirty-four cases of mastectomy with immediate breastreconstruction (IBR)were studied. We consulted both the EuropeanOrganization for Research and Treatment of Cance(EORTC) Quality-of-lifeC30 (QLQ-C30) and the Functional Assessment of CancerTherapy-Breast(FACT-B), combining our situation to designquestionnaire. We also use the Body Image Scale to investigate patientsin order to make sure our outcomes.Results: The outcomes were assessed both mailing questionnaire andtelephone to 34 patients of IBR, and we selected 67 patients of delayedbreast reconstruction(DBR) to comparison. 21 questionnaires of IBR(61.76percent)and 40 questionnaires of DBR(62.5 percent) were returned. Toconduct a statistical analysis, the Wilcoxon signed rank test, Fisher exacttests, two-sided t test, Spearman’ s correlation, and factor analysisstatistics were used. Variables analyzed included patient’ sage, cost, reasons for reconstruction, method and operation time ofreconstruction, and postoperative complications. Data analysis showedthat the treatment received by the two groups was similar in manyrespects. There was no statistical association a patient’s satisfaction with the results (P＞0.05). The QL of IBR is less affected than DBR. With thesame method, cost of IBR is lower than DBR(F=15.462, P＜0.01); operation timeof IBR is shorter than DBR (F=10.25, P＜0.01). Patients preferred simpletechnique of reconstruction, and were satisfied with the results ofreconstruction with the method of LDF. The information for IBR was mainlypromoted by oncology surgeon and DBR by Internet and TV. The reason of IBRare psychological influence without breast and for herself. We have founda strong correlation between scar of reconstructive breast and overallaesthetic results. Although overall satisfaction with breastreconstruction is undoubtedly determined by multiple and complex clinical,emotional, and psychological factors, this study suggests thatpostoperative complications are a particularly important indicator ofdissatisfaction with reconstruction.Conclusion:1. Our results confirm that patients of IBR responses regardingsatisfaction with reconstruction will reflect smaller negativepsychological and quality-of-life aspects of mastectomy.2. IBR can be used to repair the wound of recurrent sarcoma and laterbreast cancer.3. As a result of the development of new techniques that use a skin-sparingapproach and nipple-areola-preserving envelope mastectomy with IBR,the aesthetic outcome of reconstruction can be improved. In order toimprove the satisfaction, oncology surgeon and plastic surgeon shouldcooperate to benefit patient a lot.更多还原