Division of Plastic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA.
Ann Surg Oncol. 2011 Oct;18(11):3041-6. doi: 10.1245/s10434-011-1913-y. Epub 2011 Sep 27.
The potential advantages of tumescent mastectomy technique have been increasingly discussed within the literature. However, there is concern that tumescent solution may also affect postoperative complication rates. This study evaluates patient outcomes following tumescent mastectomy and immediate implant reconstruction.
Retrospective review of 897 consecutive patients (1,217 breasts) undergoing mastectomy with immediate implant reconstruction between 4/1998 and 10/2008 at a single institution was performed. Demographic and operative factors, postoperative outcomes, and overall follow-up were recorded. Complications were categorized by type and end-outcome. Fisher's exact test, Student t-test, and multiple linear regression were used for statistical analysis.
Tumescent (n = 332, 457 breasts) and nontumescent (n = 565, 760 breasts) patients were clinically similar. Mean follow-up was 36.5 months. Regression analysis demonstrated that tumescent technique increased the risk of overall complications [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.02-1.81, p = 0.04]. In particular, nonoperative and operative complications (OR 1.53, 95% CI 1.04-2.26, p = 0.04; OR 1.58, 95% CI 1.11-2.23, p = 0.01, respectively), and the rate of major mastectomy flap necrosis (OR 1.57, 95% CI 1.05-2.35, p = 0.03) were significantly affected. In patients with other, more significant risk factors, tumescent technique had an additive effect on complication rates. Additionally, the majority of tumescent breast complications (78.6%, 81/103) had at least one other significant risk factor.
Our review demonstrates that tumescent mastectomy with immediate implant reconstruction, although possessing distinct advantages, can increase postoperative complication rates. This additive effect is particularly apparent in patients with elevated complication risk at baseline. Choice of mastectomy technique should be made with careful consideration of patient comorbidities.
肿胀麻醉乳房切除术技术的潜在优势在文献中被越来越多地讨论。然而，人们担心肿胀液也可能影响术后并发症的发生率。本研究评估了肿胀麻醉乳房切除术和即刻乳房植入物重建术后的患者结局。
对 1998 年 4 月至 2008 年 10 月在一家机构接受即刻乳房植入物重建的 897 例（1217 例乳房）连续患者进行回顾性分析。记录患者的人口统计学和手术因素、术后结局和总体随访情况。将并发症按类型和最终结局进行分类。Fisher 确切检验、Student t 检验和多元线性回归用于统计分析。
肿胀组（n = 332，457 例乳房）和非肿胀组（n = 565，760 例乳房）患者的临床特征相似。平均随访时间为 36.5 个月。回归分析表明，肿胀技术增加了总体并发症的风险[比值比（OR）1.36，95%置信区间（CI）1.02-1.81，p = 0.04]。特别是非手术和手术并发症（OR 1.53，95%CI 1.04-2.26，p = 0.04；OR 1.58，95%CI 1.11-2.23，p = 0.01），以及主要乳房皮瓣坏死的发生率（OR 1.57，95%CI 1.05-2.35，p = 0.03）明显受影响。在有其他更显著危险因素的患者中，肿胀技术对并发症发生率有附加影响。此外，大多数肿胀乳房并发症（78.6%，81/103）至少有一个其他显著危险因素。
本研究表明，肿胀麻醉乳房切除术联合即刻乳房植入物重建术虽然具有明显优势，但会增加术后并发症的发生率。这种附加效应在基线时并发症风险较高的患者中尤为明显。乳房切除术技术的选择应仔细考虑患者的合并症。
