Boston, Mass. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, and the Biostatistics Program, Harvard-Thorndike General Clinical Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School.
Plast Reconstr Surg. 2010 Jun;125(6):1585-1595. doi: 10.1097/PRS.0b013e3181cb6351.
Despite a growing literature on patient satisfaction in breast reconstruction, few studies have compared perforator flaps with the more commonly practiced methods. The authors compared four reconstructive techniques and identified factors influencing patient satisfaction.
All patients undergoing postmastectomy breast reconstruction between 1999 and 2006 at a single academic institution were included in our study. A total of 583 patients with tissue expander/implant, latissimus, pedicle transverse rectus abdominis muscle (TRAM), and deep inferior epigastric perforator (DIEP) flap reconstructions received a validated questionnaire on satisfaction, health-related quality of life, and sociodemographic data.
Patient response was 75 percent, with 439 completed questionnaires including 87 tissue expander/implant, 116 latissimus, and 119 pedicle TRAM and 117 DIEP flap patients. DIEP patients had the highest level of general satisfaction at 80 percent, and pedicle TRAM patients had the highest level of aesthetic satisfaction at 77 percent (p < 0.001 and p < 0.001, respectively). Health-related quality of life and length of time since surgery were identified as significant covariates influencing patient satisfaction. After logistic regression analysis, autologous reconstruction had significantly higher general and aesthetic satisfaction than implant-based reconstruction (p = 0.017 and p < 0.001). Among the autologous reconstructions, abdominal-based flaps had significantly higher general and aesthetic satisfaction than latissimus flaps (p = 0.011 and p = 0.016). When comparing the abdominal-based reconstructions, general and aesthetic satisfaction were no longer statistically significant between pedicle TRAM and DIEP flaps (p = 0.659 and p = 0.198).
Autologous, abdominal-based reconstructions had the highest satisfaction rates across all four groups. After logistic regression analysis, differences in patient satisfaction between pedicle TRAM and DIEP flap reconstruction were no longer observed. Discussing satisfaction outcomes with patients will help them make educated decisions about breast reconstruction.
尽管有关乳房重建患者满意度的文献不断增加，但很少有研究比较皮瓣与更常用的方法。作者比较了四种重建技术，并确定了影响患者满意度的因素。
本研究纳入了 1999 年至 2006 年在一家学术机构接受乳房再造术的所有患者。共有 583 例接受组织扩张器/植入物、Latissimus 肌、带蒂横行腹直肌肌皮瓣（TRAM）和腹壁下动脉穿支皮瓣（DIEP）重建的患者收到了一份关于满意度、健康相关生活质量和社会人口统计学数据的有效问卷。
患者应答率为 75%，其中 439 份完成的问卷包括 87 例组织扩张器/植入物、116 例 Latissimus 肌和 119 例带蒂 TRAM 及 117 例 DIEP 皮瓣患者。DIEP 患者的总体满意度最高，为 80%，带蒂 TRAM 患者的美学满意度最高，为 77%（分别为 p<0.001 和 p<0.001）。健康相关生活质量和手术时间是影响患者满意度的重要协变量。经逻辑回归分析，自体重建的总体和美学满意度明显高于植入物重建（p=0.017 和 p<0.001）。在自体重建中，腹部皮瓣的总体和美学满意度明显高于 Latissimus 皮瓣（p=0.011 和 p=0.016）。比较腹部皮瓣时，带蒂 TRAM 和 DIEP 皮瓣之间的总体和美学满意度差异不再具有统计学意义（p=0.659 和 p=0.198）。
所有四组中，自体、腹部皮瓣重建的满意度最高。经逻辑回归分析，带蒂 TRAM 和 DIEP 皮瓣重建患者的满意度差异不再显著。与患者讨论满意度结果将有助于他们就乳房重建做出明智的决策。
