Mitchem Jonathan, Herrmann Dave, Margenthaler Julie A, Aft Rebecca L
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Am J Surg. 2008 Oct;196(4):519-22. doi: 10.1016/j.amjsurg.2008.06.016.
We examined the frequency and causes of tissue expander (TE) and permanent implant (PI) reconstruction failure in patients undergoing neoadjuvant chemotherapy.
Charts were reviewed from 120 patients with clinical stage II/III breast cancer enrolled between 2004 and 2007 into a prospective clinical trial of neoadjuvant chemotherapy. Patient demographics, tobacco use, radiation treatment, and data relating to the loss of TE, as well as progression to PI and PI loss, were collected.
Of 120 patients, 61 underwent 75 mastectomies. Twenty-six patients had 34 TEs placed at the time of mastectomy. Eleven (32%) TEs required removal prior to definitive reconstruction. Fourteen (41%) TEs successfully progressed to PI exchange. Four of the PIs required removal. TE loss occurred most frequently due to infection and extrusion. Radiation, smoking history, or elevated body mass index (BMI) did not significantly affect reconstruction loss.
Thirty-eight percent of immediate TEs or PI placements at the time of mastectomy failed to progress to definitive reconstruction in patients receiving neoadjuvant therapy, suggesting that reconstruction with TEs or PI reconstruction should be used cautiously in this patient population.
我们研究了接受新辅助化疗患者组织扩张器（TE）和永久性植入物（PI）重建失败的频率及原因。
回顾了2004年至2007年间纳入新辅助化疗前瞻性临床试验的120例临床II/III期乳腺癌患者的病历。收集了患者人口统计学资料、吸烟情况、放射治疗以及与TE丢失、向PI进展和PI丢失相关的数据。
120例患者中，61例行75次乳房切除术。26例患者在乳房切除时植入了34个TE。11个（32%）TE在确定性重建前需要取出。14个（41%）TE成功进展为PI置换。4个PI需要取出。TE丢失最常见的原因是感染和挤出。放射治疗、吸烟史或体重指数（BMI）升高对重建失败无显著影响。
在接受新辅助治疗的患者中，乳房切除时立即植入的TE或PI有38%未能进展为确定性重建，这表明在该患者群体中应谨慎使用TE重建或PI重建。
