Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.
UKCRC Centre of Excellence for Public Health, Belfast, United Kingdom.
PLoS One. 2018 Aug 28;13(8):e0202859. doi: 10.1371/journal.pone.0202859. eCollection 2018.
Current evidence suggests that patients who have latissimus dorsi (LD) breast reconstruction following mastectomy for breast cancer can experience long-term shoulder dysfunction. However, as there is no standardised assessment or follow-up period within the literature, findings are conflicting. This research aimed to investigate the impact on daily living of immediate and delayed LD breast reconstruction in women following mastectomy for breast cancer.
Both qualitative and quantitative methods of enquiry were used. A focus group study explored the musculoskeletal consequences of surgery as perceived by the women (n = 15) and their healthcare professionals (n = 11). A questionnaire survey was administered (n = 159), including a range of outcome measures to quantify both the physical and psychosocial impact of LD breast reconstruction. Dyad interviews were also conducted in order to determine the impact of surgery on function and activities of daily living (ADL) from the woman's perspective and that of her significant other (n = 8).
The qualitative studies highlighted a lack of preparedness and unrealistic expectations regarding functional recovery among women and their significant others'. Post-surgery it was apparent that women weighed up reduced shoulder function against survival, demonstrating resilience in their approach to coping with this adaptive way of living. The survey identified low to moderate effect on the outcomes assessed (n = 159), however, node removal significantly impacted certain aspects of quality of life (p<0.05) and disability (p = 0.04).
Breast reconstruction using the LD had an impact on shoulder function and some ADL, which impacted not only on the women but also family and significant others. Despite the functional implications associated with surgery, findings would suggest that shoulder dysfunction is not their main concern. This work identified that women and their significant other require further information to clarify expectation regarding recovery, highlighting the changing priorities of women throughout their journey from diagnosis into long-term recovery.
目前的证据表明，接受乳腺癌乳房切除术并接受 Latissimus dorsi（LD）乳房重建的患者可能会长期出现肩部功能障碍。然而，由于文献中没有标准化的评估或随访期，因此结果存在冲突。这项研究旨在调查乳腺癌乳房切除术后立即和延迟 LD 乳房重建对女性日常生活的影响。
本研究采用定性和定量方法进行研究。焦点小组研究探讨了女性（n=15）及其医疗保健专业人员（n=11）对手术引起的肌肉骨骼后果的看法。还进行了问卷调查（n=159），其中包括一系列衡量标准，以量化 LD 乳房重建对身体和社会心理的影响。还进行了对偶访谈，以从女性及其重要他人的角度确定手术对功能和日常生活活动（ADL）的影响（n=8）。
定性研究强调了女性及其重要他人对功能恢复缺乏准备和不切实际的期望。手术后，女性权衡了肩部功能的降低与生存之间的关系，表现出了应对这种适应性生活方式的韧性。调查确定了对评估结果的影响（n=159）为低到中度，但淋巴结切除术显著影响了某些生活质量（p<0.05）和残疾（p=0.04）方面。
使用 LD 进行乳房重建会对肩部功能和某些 ADL 产生影响，这不仅会影响女性，还会影响家庭和重要他人。尽管手术存在功能影响，但研究结果表明，肩部功能障碍并不是女性的主要关注点。这项工作表明，女性及其重要他人需要进一步的信息来澄清对康复的期望，突出了女性在诊断到长期康复过程中的需求变化。
