摘要
目的比较乳腺癌患者游离真皮脂肪瓣(FDFG)保乳术与传统保乳术(TBCS)并发症的差异,并分析FDFG保乳术并发症发生的影响因素。方法回顾性分析柳州市人民医院2015年6月至2020年9月120例行FDFG保乳术(FDFG组,50例)或TBCS(TBCS组,70例)乳腺癌患者的临床资料,比较两组患者总体并发症及各型并发症发生率,分析FDFG组并发症的影响因素,并行美学评价。结果两组患者在年龄、淋巴结状态、临床TNM分期等方面差异均无统计学意义(均P>0.05)。FDFG组肿瘤长径>3 cm及肿瘤位于内上象限患者比例高于TBCS组[52.0%(26/50)比27.1%(19/70),χ^(2)=7.69,P=0.006;38.0%(19/50)比15.7%(11/70),χ^(2)=7.73,P=0.005]。FDFG组手术时间、术中出血量、术后住院天数及切除组织质量均大于TBCS组[251±69)min比(213±41)min,(107±29)ml比(68±26)ml、(8.8±2.5)d比(6.1±1.6)d、(81±26)g比(56±20)g],差异均有统计学意义(t值分别为10.14、30.58、22.20、14.54,均P<0.001)。两组总体并发症发生率及出血、感染、切口愈合不良发生率差异均无统计学意义(均P>0.05),FDFG组脂肪液化发生率高于TBCS组[14.0%(7/50)比1.4%(1/70),χ^(2)=5.53,P=0.019]。多因素logistic回归分析显示,FDFG质量(OR=14.056,95%CI 1.764~111.985,P=0.013)及FDFG厚度(OR=19.599,95%CI 1.743~220.345,P=0.016)是FDFG组并发症发生的独立影响因素。FDFG组术后美学评价优良率为90%(45/50)。结论FDFG保乳术可扩大肿瘤切除范围,不增加总体并发症的发生,术后外观理想,但脂肪液化发生率高于TBCS,FDFG质量及厚度是其并发症发生的影响因素。
Objective To compare the complications between breast-conserving surgery with free dermal fat graft(FDFG)and traditional breast-conserving surgery(TBCS)in breast cancer patients,and to analyze the influencing factors for the incidence of complications of breast-conserving surgery with FDFG.Methods The clinical data of 120 breast cancer patients who underwent breast-conserving surgery with FDFG(FDFG group,50 cases)or TBCS(TBCS group,70 cases)in Liuzhou People's Hospital from June 2015 to September 2020 were retrospectively analyzed.The incidence of overall complications and various complications between the two groups were compared,the influencing factors of complications in the FDFG group were analyzed,and the cosmetic outcome was evaluated.Results There was no significant difference between the two groups in age,lymph node status,clinical TNM stage,etc(all P>0.05).In the FDFG group,the proportions of patients with the longest tumor diameter>3 cm and tumor in upper inner quadrant were significantly higher than those in the TBCS group[52.0%(26/50)vs.27.1%(19/70),χ^(2)=7.69,P=0.006;38.0%(19/50)vs.15.7%(11/70),χ^(2)=7.73,P=0.005].The operation time,intraoperative blood loss,postoperative hospital stay and weight of resected tissues in the FDFG group were higher than those in the TBCS group[(251±69)min vs.(213±41)min,(107±29)ml vs.(68±26)ml,(8.8±2.5)d vs.(6.1±1.6)d,(81±26)g vs.(56±20)g],and the differences were statistically significant(t values were 10.14,30.58,22.20,and 14.54,respectively,all P<0.001).There were no significant differences in the incidence of overall complications,bleeding,infection,or poor wound healing between the two groups(all P>0.05).The incidence rate fat liquefaction in the FDFG group was higher than that in the TBCS group[14.0%(7/50)vs.1.4%(1/70),χ^(2)=5.53,P=0.019].Multivariate logistic regression analysis showed that the weight of FDFG(OR=14.056,95.0%CI 1.764-111.985,P=0.013)and the thickness of FDFG(OR=19.599,95.0%CI 1.743-220.345,P=0.016)were independent influencing factors for the incidence of complications in the FDFG group.The percentage of'excellent'or'good'cosmetic outcome in the FDFG group was 90%(45/50).Conclusions Breast-conserving surgery with FDFG can extend the resected area for tumor without increasing the incidence of overall complications and could provide patients a superior cosmetic outcome,but the incidence of fat liquefaction is higher than that of TBCS.The weight and thickness of FDFG are the influencing factors for the incidence of complications of breast-conserving surgery with FDFG.
作者
黄佳鹏
庄亚强
周韬
曹一鸣
韦德飞
石青梅
Huang Jiapeng;Zhuang Yaqiang;Zhou Tao;Cao Yiming;Wei Defei;Shi Qingmei(Department of Breast and Thyroid Surgery 2,Liuzhou People's Hospital,Liuzhou 545006,China)
出处
《肿瘤研究与临床》
CAS
2022年第3期184-188,共5页
Cancer Research and Clinic
基金
广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190012)。
关键词
乳腺肿瘤
外科皮瓣
真皮
脂肪组织
并发症
Breast neoplasms
Surgical flaps
Dermis
Adipose tissue
Complications
