65 岁以上女性的直接植入式乳房重建：并发症发生率和总体结果的回顾性分析。
Direct-to-Implant Breast Reconstruction in Women Older than 65 Years: A Retrospective Analysis of Complication Rate and Overall Outcomes.
机构信息
MetroHealth, Cleveland, Ohio.
From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation.
出版信息
Plast Reconstr Surg. 2018 Feb;141(2):251-256. doi: 10.1097/PRS.0000000000004015.
BACKGROUND
Half of all cancers occur in women older than 65 years, yet only 4 to 14 percent of these women undergo reconstruction. Most studies on reconstruction in the elderly have focused on tissue expander/implant or autologous reconstruction. A direct-to-implant approach theoretically reduces the number of operations and postoperative visits, but has yet to be investigated in the elderly.
METHODS
Institutional review board approval was granted for a retrospective chart review for patients who underwent direct-to-implant reconstruction from 2012 to 2015 with any staff in the authors' department. A control cohort of patients who underwent tissue expander/implant-based reconstruction from the same period was analyzed.
RESULTS
Direct-to-implant reconstruction was performed in 24 breasts in 19 patients with at least 30-day follow-up and in 17 breasts in 14 patients with at least 1-year follow-up. A control group analysis of tissue expander/implant patients was performed for 109 breasts in 88 patients. The tissue expander/implant group was significantly younger (p = 0.001), with a lower body mass index (p = 0.004). There was no difference in the rate of seroma, hematoma, infection, necrosis, or failed reconstruction. Direct-to-implant patients had significantly reduced numbers of drain days (p < 0.001), length of stay (p = 0.05 and p = 0.039), readmissions (p = 0.03 and 0.03), extra hospital days (p = 0.05 and p = 0.045), and postoperative visits (p < 0.001).
CONCLUSIONS
Direct-to-implant breast reconstruction in the elderly yields similar complication and failure rates compared to tissue expander/implant reconstruction. However, direct-to-implant reconstruction patients had a reduced number of drain days and fewer readmissions, hospital stays, and postoperative visits. Direct-to-implant reconstruction is a powerful tool to use in elderly women with appropriate breast shape and ptosis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
所有癌症中有一半发生在 65 岁以上的女性中，但只有 4%到 14%的女性接受了重建。大多数关于老年人重建的研究都集中在组织扩张器/植入物或自体重建上。直接植入的方法理论上可以减少手术次数和术后就诊次数，但尚未在老年人中进行研究。
方法
机构审查委员会批准对 2012 年至 2015 年间在作者所在部门的任何工作人员处接受直接植入重建的患者进行回顾性图表审查，并对同期接受组织扩张器/植入物重建的患者进行了对照分析。
结果
24 例患者的 19 侧乳房进行了直接植入重建，至少随访 30 天；17 例患者的 14 侧乳房至少随访 1 年进行了直接植入重建。对 88 例患者的 109 例组织扩张器/植入物患者进行了对照组分析。组织扩张器/植入物组明显更年轻（p=0.001），体质量指数更低（p=0.004）。血清肿、血肿、感染、坏死或重建失败的发生率没有差异。直接植入组的引流天数明显减少（p<0.001），住院时间（p=0.05 和 p=0.039）、再入院率（p=0.03 和 p=0.03）、额外住院天数（p=0.05 和 p=0.045）和术后就诊次数（p<0.001）明显减少。
结论
与组织扩张器/植入物重建相比，老年患者直接植入乳房重建的并发症和失败率相似。然而，直接植入组的引流天数减少，再入院率、住院时间和术后就诊次数减少。直接植入重建是一种在具有适当乳房形状和下垂的老年女性中使用的有力工具。
临床问题/证据水平：治疗性，III 级。
Zotero 插件