【摘要】 目的总结一步法和二步法乳房重建的临床经验,并探讨其适应证、效果及可行性。方法收集2013年9月～2017年11月我院行乳房重建的乳腺癌病人,比较一步法和二步法术后并发症以及美容效果的差异。结果术中合成补片的使用与术后伤口愈合不良(OR:4.40,95%CI:1.27～15.29,P=0.02)及积液(OR:9.30,95%CI:1.60～53.93,P=0.01)的发生有关,放疗与包膜挛缩的发生明显相关(OR:0.12,95%CI:0.03～0.49,P=0.003)。调整合成补片的使用和放疗因素后,两种重建方式在术后并发症方面无明显差异。二步法术后病人外观满意度高于一步法,差异有统计学意义(P <0.001)。结论 0～Ⅱ期乳腺癌病人行一步法或二步法乳房重建均能满足肿瘤安全性和形体美容效果,重建方案的选择需综合病人病情进展程度、乳房形态、肿块位置、主观意愿等原因,制定个性化的重建方案。更多还原

【Abstract】 Objective To evaluate the outcome of the one-stage and two-stage implant-based breast reconstruction( IBBR) in terms of postoperative complications and patient satisfaction. Methods Clinical datawere retrospectively collected for patients who underwent one-stage and two-stage IBBR from2013 to 2017. Postoperative complications,reoperations and patients’ satisfaction were compared between the two groups. Results Biological patch resulted an increased risk of poor healing wound( OR: 4. 40,95% CI: 1. 27-15. 29,P = 0. 02) and seroma( OR: 9. 30,95% CI: 1. 60-53. 93,P = 0. 01). Radiotherapy resulted an increased risk of capsular contracture( OR: 0. 12,95% CI: 0. 03-0. 49,P = 0. 003). The above complications appeared to be independent of operation mode. Two-stage IBBR only had more satisfactory aesthetic outcomes compared to one-stage IBBR( P < 0. 001),with no difference in complications and reoperations. Conclusion Both one-stage and two-stage IBBR could satisfy tumor safety and cosmetic effect. We recommend that the choice of techniquesshould be considered on a case-by-case basis.更多还原