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目的近年来随着乳腺癌的早期发现和治愈率不断提高,患者对自身形态的要求远远大于对疾病的恐惧。因此,如何选择更好的方法恢复患者身体形态是当前医生需考虑的首要问题。本研究比较保留乳头乳晕的全乳腺切除术+即刻乳房重建(NSM+IBR)与标准改良根治术+即刻乳房重建(MRM+IBR)的并发症、美容效果和疗效,探讨NSM+IBR的临床应用价值。方法选择山东省临沂市肿瘤医院乳腺科2006-12-01-2012-10-01收治的初诊为乳腺癌(0~Ⅱ期)患者共56例,其中NSM+IBR组共32例,MRM+IBR组共24例,所有患者均采用背阔肌肌皮瓣重建乳房,比较两组患者的手术后并发症、美容效果和局部复发、远处转移情况。结果两组患者平均随访70.48个月,中位随访84个月,均未出现局部复发,NSM+IBR组远处转移2例,MRM+IBR组远处转移1例,两组远处转移发生率差异无统计学意义,P=0.608。MRM+IBR组发生血清肿共7例,皮瓣缺血2例,切口感染1例,切口裂开1例;NSM+IBR组发生血清肿共8例,乳头乳晕或皮瓣缺血共10例,切口感染1例,切口裂开2例;其中,皮瓣缺血发生率NSM+IBR组高于MRM+IBR组,差异有统计学意义(χ~2=8.727,P=0.003),其余并发症两组间差异无统计学意义,均P>0.05。美容效果评价,MRM+IBR组优为5例,良为13例,一般为6例,差为0例;NSM+IBR组优为25例,良为6例,一般为1例,差为0例;两组间美容效果差异有统计学意义,P=0.020。结论 NSM+IBR具有安全有效、美容效果好等优点,为有乳房重建愿望的乳腺癌患者提供了更多选择。
Purpose In recent years, with the early detection of breast cancer and the rising rate of cure, patients with their own form requirements far greater than the fear of the disease. Therefore, how to choose a better way to restore the patient’s body shape is the primary issue that current doctors should consider. In this study, we compared the complications, cosmetic effects and curative effects of total mastectomy with immediate breast reconstruction (NSM + IBR) with standard modified radical mastectomy + immediate breast reconstruction (MRM + IBR), and discussed the clinical application of NSM + IBR value. Methods 56 patients with newly diagnosed breast cancer (stage 0 ~ Ⅱ) admitted to Linyi Tumor Hospital of Shandong Province from December 2006 to January 2006 were enrolled. There were 32 cases in NSM + IBR group, MRM + IBR A total of 24 cases, all patients with latissimus dorsi muscle flap reconstruction breast, comparisons of postoperative complications, cosmetic effect and local recurrence, distant metastasis of two groups of patients. Results The two groups were followed up for an average of 70.48 months with a median follow-up of 84 months. There were no local recurrences in both groups. There were 2 cases of distant metastasis in NSM + IBR group and 1 case of distant metastasis in MRM + IBR group. The incidence of distant metastasis The difference was not statistically significant, P = 0.608. MRM + IBR group had 7 cases of serum edema, 2 cases of flap ischemia, 1 case of incision infection and 1 case of incision. Serum swollen in NSM + IBR group was 8 cases, nipple areola or flap ischemia in 10 cases , Incision infection in 1 case and incision rupture in 2 cases. The incidence of ischemic skin flap in NSM + IBR group was higher than that in MRM + IBR group (χ ~ 2 = 8.727, P = 0.003) There was no significant difference between the two groups, all P> 0.05. In the evaluation of cosmetic results, the MRM + IBR group had 5 excellent cases, 13 good cases, 6 fair cases and 0 poor cases. Among the 25 cases of NSM + IBR group, 25 cases were excellent, 6 cases were good, 1 case was poor, and 0 was poor Cases; cosmetic effect between the two groups was statistically significant, P = 0.020. Conclusion NSM + IBR has the advantages of being safe and effective, having good cosmetic effects, and provides more choices for patients with breast cancer who desire breast reconstruction.