Jia-Jian Chen, Nai-Si Huang, Jing-Yan Xue, Ben-Long Yang, Guang-Yu Liu, Gen-Hong Di, Zhi-Min Shao, Jiong Wu
From the Department of Breast Surgery, Fudan University Shanghai Cancer Center; and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China (CJJ, HNS, XJY, YBL, LGY, DGH, SZM, WJ).
Medicine (Baltimore). 2015 Aug;94(34):e1399. doi: 10.1097/MD.0000000000001399.
The study of this study is to assess the current status and trend of the application of breast reconstruction in China.A retrospective review of all patients who had received surgical treatment for breast cancer in the Fudan University Shanghai Cancer Center between January 1999 and June 2014 was performed. The clinicopathological and epidemiological parameters and the follow-up information of each patient were collected.A total of 20,551 patients with 20,974 surgeries were identified. Of those, the rates of patients received mastectomy, breast conserving therapy, and breast reconstruction were 81.2% (17,040 cases), 15.3% (3216 cases), and 3.4% (718 cases), respectively. Skin-sparing mastectomy with autologous breast reconstruction was algate the dominant option for breast reconstruction although a rapid growth in the application of prosthetic reconstructions was observed in recent years. The rates of complications that required reoperation in patients reconstructed with latissimus dorsi myocutaneous flap, pedicled transverse rectus abdominis myocutaneous flap, free flaps, and prosthesis were 1.2%, 8.5%, 11.4%, and 10.5%, respectively, while the revision rates were 0.7%, 6.1 %, 5.3%, and 2.3%, respectively. Multiple regression analysis confirmed that types of surgery did not affect the disease-free survival of breast cancer patients.Skin-sparing mastectomy with breast reconstruction is oncologically safe while achieving satisfactory aesthetic outcomes. Autologous reconstruction remains the most commonly used technique while there is a rapid increase of prosthetic reconstruction in recent years. The low demand for breast aesthetics among Chinese women, defects of healthcare system, and the limited availability of recourses impeded the development of breast reconstruction techniques in China.
本研究旨在评估中国乳房重建的应用现状及趋势。对1999年1月至2014年6月期间在复旦大学附属肿瘤医院接受乳腺癌手术治疗的所有患者进行回顾性研究。收集每位患者的临床病理和流行病学参数以及随访信息。共确定了20551例患者，进行了20974次手术。其中，接受乳房切除术、保乳治疗和乳房重建的患者比例分别为81.2%（17040例）、15.3%（3216例）和3.4%（718例）。尽管近年来假体重建的应用迅速增长，但保留皮肤的乳房切除术联合自体乳房重建仍是乳房重建的主要选择。采用背阔肌肌皮瓣、带蒂腹直肌肌皮瓣、游离皮瓣和假体进行重建的患者中，需要再次手术的并发症发生率分别为1.2%、8.5%、11.4%和10.5%，而修复率分别为0.7%、6.1%、5.3%和2.3%。多元回归分析证实手术方式不影响乳腺癌患者的无病生存率。保留皮肤的乳房切除术联合乳房重建在肿瘤学上是安全的，同时能获得满意的美学效果。自体重建仍然是最常用的技术，而近年来假体重建的应用迅速增加。中国女性对乳房美学的需求较低、医疗保健系统存在缺陷以及资源有限阻碍了中国乳房重建技术的发展。
