摘要
目的评估放疗对上蒂横行腹直肌肌皮瓣（TRAM）乳房再造的影响。方法回顾性分析2009年6月—2012年6月于天津医科大学肿瘤医院行上蒂TRAM术式乳腺癌490例，去除双乳再造18例，分为4组，A组即刻乳房再造＋术后放疗组（123例），B．组即刻乳房再造无放疗组（262例），C组放疗后择期乳房再造组（34例），D组延期乳房再造无放疗组（53例）。主要评估指标为：术后3个月及术后或放疗后1年术后并发症及腹部功能、外观及心理学（BREAST-Q量表）评分，放疗对上蒂TRAM乳房再造的影响。结果1．1％患者术后发生皮瓣坏死，2．5％切口延期愈合，1．1％血管栓塞，6．1％脂肪液化；7．0％患者术后发生脂肪坏死，5．3％再造乳房缩小，3．6％皮瓣挛缩，0．8％腹壁膨出及疝。与无放疗组患者相比，放疗组患者在肿瘤临床分期方面差异有统计学意义（P〈0．05）。本组平均随访时间（24．98±6．99）个月。在术后早期并发症方面差异均无统计学意义（均P〉0．05），术后或放疗后晚期并发症方面差异有统计学意义（均P〈0．05）。各组患者在同一随访点对乳房美学、腹部功能与外观及心理学评价差异均无统计学意义（均P〉0．05）。结论TRAM乳房重建患者中，术前明确无需术后放疗者，可行即刻乳房重建；术后需放疗者，应在完成放疗后再行乳房重建。
Objective To assess the impact of radiation on superior epigastric vessel pedicled transverse rectus abdominal myocutaneous （TRAM） for breast reconstruction. Methods Female breast cancer patients were divided into 4 groups ： group A （ immediate breast reconstruction ＋ radiation therapy, 123 cases）, group B （immediate breast reconstruction,262 cases） , group C （radiation therapy ＋ delayed breast reconstruction,34 cases）, group D （delayed breast reconstruction,53 cases） from June 2009 to June 2012 at Department of Breast Oncology, Tianjin Medical University. Patient demographics, operative details, radiation therapy details, postoperative complications, patient-centered evaluation of aesthetic and psychological outcomes were assessed. Results The average follow-up duration was 24. 98 ± 6. 99 months. 2. 5% patients developed delayed wound healing postoperatively. Fat necrosis and flap contraeture were seen in 7.0% and 3.6% of all patients, respectively. Irradiated patients had a significant statistical difference in cancer staging, involved lymph nodes, tissue invasion and neoadjuvant chemotherapy （ P 〈 0. 05 ）. No significant statistical differences were observed in post-operative early complications, but in advanced stage complications. There was no significantly statistical difference in breast aesthetic outcome before and after radiation therapy within four groups. Conclusions For breast reconstruction patients, those without postoperative radiotherapy were suggested immediate breast reconstruction, and those with postoperative radiotherapy were proposed to accomplish breast reconstruction after postoperative radiotherapy.
出处
《中华普通外科杂志》
CSCD
北大核心
2015年第8期627-630,共4页
Chinese Journal of General Surgery
