英国乳房切除术后即刻乳房重建的趋势
Trends in Immediate Postmastectomy Breast Reconstruction in the United Kingdom.
作者信息
Leff Daniel R, Bottle Alex, Mayer Erik, Patten Darren K, Rao Christopher, Aylin Paul, Hadjiminas Dimitri J, Athanasiou Thanos, Darzi Ara, Gui Gerald
机构信息
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
出版信息
Plast Reconstr Surg Glob Open. 2015 Sep 4;3(9):e507. doi: 10.1097/GOX.0000000000000484. eCollection 2015 Sep.
BACKGROUND
The study aimed to evaluate local and national trends in immediate breast reconstruction (IBR) using the national English administrative records, Hospital Episode Statistics. Our prediction was an increase in implant-only and free flap procedures and a decline in latissimus flap reconstructions.
METHODS
Data from an oncoplastic center were interrogated to derive numbers of implant-only, autologous latissimus dorsi (LD), LD-assisted, and autologous pedicled or free flap IBR procedures performed between 2004 and 2013. Similarly, Hospital Episode Statistics data were used to quantify national trends in these procedures from 1996 to 2012 using a curve fitting analysis.
RESULTS
National data suggest an increase in LD procedures between 1996 (n = 250) and 2002 (n = 958), a gradual rise until 2008 (n = 1398) followed by a decline until 2012 (n = 1090). As a percentage of total IBR, trends in LD flap reconstruction better fit a quadratic (R(2) = 0.97) than a linear function (R(2) = 0.63), confirming a proportional recent decline in LD flap procedures. Conversely, autologous (non-LD) flap reconstructions have increased (1996 = 0.44%; 2012 = 2.76%), whereas implant-only reconstructions have declined (1996 = 95.42%; 2012 = 84.92%). Locally, 70 implant-assisted LD procedures were performed in 2003 -2004, but only 2 were performed in 2012 to 2013.
CONCLUSIONS
Implants are the most common IBR technique; autologous free flap procedures have increased, and pedicled LD flap procedures are in decline.
背景
本研究旨在利用英国国家行政记录“医院事件统计数据”评估即刻乳房重建（IBR）的地区和全国趋势。我们的预测是单纯植入和游离皮瓣手术会增加，而背阔肌皮瓣重建手术会减少。
方法
对一家肿瘤整形中心的数据进行分析，得出2004年至2013年间单纯植入、自体背阔肌（LD）、LD辅助以及自体带蒂或游离皮瓣IBR手术的数量。同样，利用“医院事件统计数据”，通过曲线拟合分析量化1996年至2012年这些手术的全国趋势。
结果
全国数据显示，1996年（n = 250）至2002年（n = 958）期间LD手术数量增加，到2008年（n = 1398）逐渐上升，随后到2012年（n = 1090）下降。作为IBR总数的百分比，LD皮瓣重建的趋势更符合二次函数（R² = 0.97）而非线性函数（R² = 0.63），证实了近期LD皮瓣手术数量按比例下降。相反，自体（非LD）皮瓣重建有所增加（1996年 = 0.44%；2012年 = 2.76%），而单纯植入重建则有所下降（1996年 = 95.42%；2012年 = 84.92%）。在当地，2003 - 2004年进行了70例植入辅助LD手术，但2012年至2013年仅进行了2例。
结论
植入是最常见的IBR技术；自体游离皮瓣手术增加，带蒂LD皮瓣手术减少。
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