乳房切除术后乳房重建：从长期来看它能减轻抑郁吗？
Breast reconstruction after mastectomy: does it decrease depression at the long-term?
作者信息
de Raaff Christel Aurora Louise, Derks Eveline Anne-Jet, Torensma Bart, Honig Adriaan, Vrouenraets Bartholomeus Cornelius
机构信息
Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands ;
Department of Anesthesiology, LU Medical Center, Leiden, the Netherlands ;
出版信息
Gland Surg. 2016 Aug;5(4):377-84. doi: 10.21037/gs.2016.05.02.
BACKGROUND
Depression is associated with breast cancer survivors in 22%. Although breast reconstruction (BR) is intended to provide psychological improvements such as reducing depression, literature is inconclusive and without long-term follow-up. The objective is to evaluate the impact of BR after breast cancer related mastectomy on the long-term depression risk and assess predictive factors for depression.
METHODS
Women who underwent a curative mastectomy between 1999 and 2009 were included. After a mean follow-up of more than 6 years after operation, the Beck Depression Inventory-13 (BDI-13) evaluated depressive symptoms. Multivariable regression analysis provided predictors for depression.
RESULTS
A total of 139 patients, 34 (24.5%) with and 105 (75.5%) without BR, were analyzed. Seventy-seven patients (48.2%) were at high risk for mild (n=58), moderate (n=5) or severe (n=4) depression. There was a trend for slightly better BDI-13 outcomes for women who underwent BR (2 vs. 4; P=0.06). Living alone [odds ratio (OR): 2.16; P=0.04], low educational level (OR: 3.70; P<0.01) and adjuvant hormonal/endocrine-therapy (OR: 2.36; P=0.02) were associated with an increased depression risk.
CONCLUSIONS
BR has no clear influence on depressive symptoms on the long-term. Predictive factors should alert clinicians to assess depressive symptoms in specific breast cancer patients during follow-up.
背景
22%的乳腺癌幸存者伴有抑郁症。尽管乳房重建（BR）旨在改善心理状况，如减轻抑郁，但相关文献尚无定论且缺乏长期随访。目的是评估乳腺癌相关乳房切除术后乳房重建对长期抑郁风险的影响，并评估抑郁的预测因素。
方法
纳入1999年至2009年间接受根治性乳房切除术的女性。术后平均随访6年以上，采用贝克抑郁量表-13（BDI-13）评估抑郁症状。多变量回归分析提供抑郁的预测因素。
结果
共分析139例患者，其中34例（24.5%）接受了乳房重建，105例（75.5%）未接受。77例患者（48.2%）有轻度（n=58）、中度（n=5）或重度（n=4）抑郁的高风险。接受乳房重建的女性BDI-13结果有稍好的趋势（2比4；P=0.06）。独居（优势比[OR]：2.16；P=0.04）、低教育水平（OR：3.70；P<0.01）和辅助激素/内分泌治疗（OR：2.36；P=0.02）与抑郁风险增加相关。
结论
乳房重建对长期抑郁症状无明显影响。预测因素应提醒临床医生在随访期间评估特定乳腺癌患者的抑郁症状。
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