Duymaz Tomris, İyigün Zeynep Erdoğan, İlgün Ahmet Serkan, Ordu Çetin, Üçüncü Muhammed, Alço Gül, Öztürk Alper, Elbüken Filiz, Aktepe Fatma, Özmen Vahit
Department of Physiotherapy and Rehabilitation, İstanbul Bilgi University School of Health Sciences, İstanbul, Turkey.
Department of Physiotherapy and Rehabilitation, İstanbul Bilim University School of Medicine, İstanbul, Turkey.
Eur J Breast Health. 2019 Jul 1;15(3):158-162. doi: 10.5152/ejbh.2019.4727. eCollection 2019 Jul.
The aim of this study is to investigate the effect of mini latissimus dorsi flap (MLDF) reconstruction on ipsilateral shoulder functions.
Those included in the study are the patients aged between 23 and 73, who were operated with the diagnosis of early breast cancer (cT1-3)N0). The first group includes the patients who had sentinel lymph node biopsy (SLNB) with partial mastectomy. The second group consists of the patients who had axillary lymph nodule dissection (ALND) with partial mastectomy. The third group includes the patients who had SLNB and MLDF with partial mastectomy. The fourth group includes the patients who had ALND and MLDF with partial mastectomy. Patients' Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score work model point were recorded.
174 patients were included in this study. According to Q-DASH score, no functional change was detected in 69.5% of the patients, whereas slight functional loss was identified in 23.6%, moderate functional loss in 5.7%, severe functional loss 1.1%. In the comparison of Q-DASH scores in surgery groups, while these four groups were being analyzed, a significant difference was determined (p=0.007). When dual analyses were made, it was also established that the difference resulted from the group to which ALND and MLDF were applied together.
We conclude that MLDF application for reconstruction purposes after breast surgery has a negative impact on shoulder functions of the patients who had both of partial mastectomy and ALND.
本研究旨在探讨背阔肌小肌皮瓣（MLDF）重建对同侧肩部功能的影响。
纳入研究的患者年龄在23至73岁之间，诊断为早期乳腺癌（cT1 - 3N0）并接受手术治疗。第一组包括接受保乳手术并进行前哨淋巴结活检（SLNB）的患者。第二组由接受保乳手术并进行腋窝淋巴结清扫（ALND）的患者组成。第三组包括接受保乳手术、SLNB及MLDF的患者。第四组包括接受保乳手术、ALND及MLDF的患者。记录患者的手臂、肩部和手部快速功能障碍（Q - DASH）评分工作模型点。
本研究共纳入174例患者。根据Q - DASH评分，69.5%的患者未检测到功能变化，23.6%的患者有轻微功能丧失，5.7%的患者有中度功能丧失，1.1%的患者有严重功能丧失。在手术组Q - DASH评分比较中，对这四组进行分析时，差异有统计学意义（p = 0.007）。进行双重分析时还发现，差异源于同时应用ALND和MLDF的组。
我们得出结论，乳腺癌手术后应用MLDF进行重建对同时接受保乳手术和ALND的患者的肩部功能有负面影响。
