Roth Randy S, Lowery Julie C, Davis Jennifer, Wilkins Edwin G
University of Michigan Health System, Department of Physical Medicine, Ann Arbor, MI 48108, USA.
Ann Plast Surg. 2007 Apr;58(4):371-6. doi: 10.1097/01.sap.0000239810.38137.84.
This study prospectively examined the long-term effects of type (transverse rectus abdominis musculocutaneous [TRAM] versus implant) and timing (immediate versus delayed) of postmastectomy reconstructive surgery on patient reports of pain at multiple body sites. Women (n = 205) seeking immediate or delayed breast reconstruction, choosing either expander implant or autologous tissue transfer surgical procedures, provided ratings for the presence of bodily, breast, abdominal, and back pain and abdominal tightness prior to surgery and at 2-year follow-up. At baseline, nonwhite women were more likely to undergo delayed reconstruction (P < 0.05), and women seeking delayed reconstruction had less breast pain (P < 0.001) and more back pain (P < 0.01). Multiple regression analyses, controlling for ethnicity and baseline pain, indicated that women receiving TRAM flap surgery reported more problems with abdominal pain and tightness. There was a trend for implant subjects to report more frequent problems with breast pain. These results suggest the need for heightened awareness of potential long-term pain morbidity for women undergoing TRAM flap or implant breast reconstruction.
本研究前瞻性地考察了乳房切除术后重建手术的类型（腹直肌肌皮瓣[TRAM]与植入物）和时机（即刻与延迟）对患者多个身体部位疼痛报告的长期影响。寻求即刻或延迟乳房重建的女性（n = 205），选择扩张器植入或自体组织转移手术，在手术前及2年随访时对身体、乳房、腹部和背部疼痛以及腹部紧绷情况进行评分。在基线时，非白人女性更有可能接受延迟重建（P < 0.05），寻求延迟重建的女性乳房疼痛较少（P < 0.001），背部疼痛较多（P < 0.01）。在控制种族和基线疼痛的多元回归分析中，接受TRAM皮瓣手术的女性报告腹部疼痛和紧绷问题更多。植入物受试者有报告乳房疼痛问题更频繁的趋势。这些结果表明，对于接受TRAM皮瓣或植入物乳房重建的女性，需要提高对潜在长期疼痛发病率的认识。
