基于植入物的乳房重建中的包膜挛缩——猪脱细胞真皮基质的作用
Capsular contracture in implant based breast reconstruction-the effect of porcine acellular dermal matrix.
作者信息
Lardi Alessia M, Ho-Asjoe Mark, Junge Klaus, Farhadi Jian
机构信息
Department of Plastic & Reconstructive Surgery, Guy's and St. Thomas Hospital, London, UK; ; Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland.
Department of Plastic & Reconstructive Surgery, Guy's and St. Thomas Hospital, London, UK.
出版信息
Gland Surg. 2017 Feb;6(1):49-56. doi: 10.21037/gs.2017.01.02.
BACKGROUND
Irradiation of implant-based breast reconstructions (BR) is known to increase capsular contracture (CC) rates on average by 4-fold over non-irradiated reconstructions. The use of acellular dermal matrix (ADM) has been associated with lower CC rates in non-irradiated reconstructions (0-3%). Experimental and clinical studies suggest that ADM may also reduce CC rates in irradiated breasts. The aim of this study was to evaluate CC rates in non-irradiated and irradiated one- and two-stage BRs performed with the assistance of porcine ADM (PADM).
METHODS
A single centre, retrospective, cohort study was designed from December 2008 to October 2012. A total of 200 immediate implant-based BRs were performed using PADM for inferior pole reinforcement. We included non-irradiated BR with a minimum follow up of 6 month from primary surgery (one stage) or from explantation of expander and implantation of the definitive implant (two stage). Of the postoperatively irradiated BR we included patients with 1 year or more follow up time from termination of radiotherapy. CC was graded using the conventional Spear-Baker classification and modified version for irradiated BR. According to the literature Grade III and IV CC were defined as clinically significant CC.
RESULTS
Of 200 BRs with PADM, 122 were included in this study (84 non-irradiated and 38 irradiated). Sixty-five BR were one stage and 57 were two stage BR. Grade III/IV CC was remarkable low in non-irradiated (6%) and irradiated BR (13%). There was a non-significant trend to increased Grade III and IV CC in irradiated BR non-irradiated BR (13% 6%, P=0.216). In this study follow up time (P<0.001) and the stage of ADM reconstruction (two one stage, P=0.022) were significant risk factors for occurrence of grade III/IV CC on univariate analysis and remained significant for the follow up time (P=0.013) and remarkable for the stages (P=0.093) in multivariate analysis.
CONCLUSIONS
Our data support the current clinical evidence that ADM use in implant-based BR is associated with a reduced risk of CC when compared to the standard submuscular techniques in literature. The reduced risk is maintained in the setting of radiotherapy. Two stage procedures in our study population showed increased grade III/IV CC compared to one stage procedures with or without exposure to radiation.
背景
已知基于植入物的乳房重建术（BR）接受放疗后，包膜挛缩（CC）发生率平均比未接受放疗的重建术高4倍。在未接受放疗的重建术中，使用脱细胞真皮基质（ADM）与较低的CC发生率相关（0%-3%）。实验和临床研究表明，ADM也可能降低接受放疗的乳房的CC发生率。本研究的目的是评估在猪脱细胞真皮基质（PADM）辅助下进行的未接受放疗和接受放疗的一期及二期BR的CC发生率。
方法
设计了一项单中心、回顾性队列研究，时间跨度为2008年12月至2012年10月。共进行了200例基于植入物的即刻BR，使用PADM加强下极。我们纳入了未接受放疗的BR，从初次手术（一期）或从取出扩张器并植入最终植入物（二期）起至少随访6个月。在术后接受放疗的BR中，我们纳入了放疗结束后随访时间为1年或更长时间的患者。使用传统的Spear-Baker分类法和针对接受放疗的BR的改良版本对CC进行分级。根据文献，III级和IV级CC被定义为具有临床意义的CC。
结果
在200例使用PADM的BR中，本研究纳入了122例（84例未接受放疗，38例接受放疗）。65例BR为一期，57例为二期BR。在未接受放疗的BR（6%）和接受放疗的BR（13%）中，III/IV级CC发生率极低。接受放疗的BR与未接受放疗的BR相比，III级和IV级CC有增加的趋势，但差异无统计学意义（13%对6%，P=0.216）。在本研究中，单因素分析显示随访时间（P<0.001）和ADM重建分期（二期对一期，P=0.022）是发生III/IV级CC的显著危险因素，多因素分析中随访时间（P=0.013）仍然显著，分期（P=0.093）也有显著意义。
结论
我们的数据支持当前临床证据，即与文献中的标准胸大肌下技术相比，在基于植入物的BR中使用ADM与降低CC风险相关。在放疗情况下，这种降低的风险得以维持。在我们的研究人群中，与一期手术相比，二期手术无论是否接受放疗，III/IV级CC发生率均增加。
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