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[基于植入物的乳房重建的当前实践:中国全国实践问卷调查结果]

[Current practice of implant-based breast reconstruction: results from China national practice questionnaire survey].

作者信息

Guo R, Xiu B Q, Su Y H, Wang J, Zhang Q, Chi W R, Li L, Yang B L, Zhang Y Y, Cao A Y, Shao Z M, Wu J

机构信息

Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2019 Aug 1;57(8):616-621. doi: 10.3760/cma.j.issn.0529-5815.2019.08.010.

Abstract

To explore the current clinical practice of implant-based breast reconstruction (IBBR) in China. The current survey was sponsored by Chinese Anti-Cancer Association, Committee of Breast Cancer Society and Chinese Society of Breast Surgeons. A survey was mailed to 110 hospitals in China, which have more than 200 breast cancer operations performed in 2017. The survey mainly included questions on the clinical practice of IBBR, sociodemographic and geographical factors associated with IBBR practice, reasons and concerns for selecting IBBR, type and timing of breast reconstruction, and the complications of IBBR. Data were analyzed using χ(2) test, Fisher's exact test or Kruskal-Wallis rank sum test. IBBR was available in 86.4% (95/110) included hospitals. It was predominantly performed breast reconstruction surgery, the proportion of IBBR in all the breast reconstruction was 65.75% (4 296/6 534). However, the rate of IBBR in all the patients received mastectomy was only 7.06% (4 296/60 877). Among all the included hospitals, the number of implant reconstructions performed in 2017 was 24 (57.5) cases ((), range: 2-565 cases). Factors associated with the performance of IBBR including regional per capita gross domestic product (10.47, 0.005) and annual surgery volume (8.30, 0.016). The main reasons for choosing IBBR were relatively simple surgical procedure, short learning curve and short operation time. The effects of adjuvant radiotherapy on prosthesis, postoperative complications and patient satisfaction were the main concerns for implant reconstruction. Compared with delay reconstruction, a higher proportion of IBBR was observed in immediate reconstruction (83.1% . 62.0%, χ(2)=12.522, 0.000). In all, 10.5% (10/95) hospitals reported more than 10% grade Ⅲ to Ⅳ capsular contracture. The incidence of infections need surgical intervention was reported between 10% and 20% by 4.2% (4/95) hospitals. Hospitals with 6% to 10% implant rupture and 6% to 15% implant removal were 1.1% (1/95) and 4.2% (4/95) respectively. IBBR was the most common used surgery in breast reconstruction after mastectomy. However, the proportion of IBBR in patients after mastectomy was still low. Reginal economy, surgery volume of hospitals, lack of specialty training program and the concern about complications and patient's satisfaction were the factors affecting the development of IBBR.

摘要

探索中国基于植入物的乳房重建(IBBR)的当前临床实践情况。本次调查由中国抗癌协会、乳腺癌专业委员会和中国乳腺外科医师学会发起。向中国110家医院邮寄了调查问卷,这些医院在2017年进行了200多例乳腺癌手术。该调查主要包括关于IBBR临床实践、与IBBR实践相关的社会人口统计学和地理因素、选择IBBR的原因及顾虑、乳房重建的类型和时机以及IBBR的并发症等问题。数据采用χ(2)检验、Fisher精确检验或Kruskal-Wallis秩和检验进行分析。在纳入调查的110家医院中,86.4%(95/110)的医院开展了IBBR。这些医院主要进行乳房重建手术,IBBR在所有乳房重建中的比例为65.75%(4296/6534)。然而,在所有接受乳房切除术的患者中,IBBR的比例仅为7.06%(4296/60877)。在所有纳入调查的医院中,2017年进行的植入物重建手术数量为24(中位数57.5)例(范围:2 - 565例)。与IBBR开展情况相关的因素包括地区人均国内生产总值(10.47,P = 0.005)和年手术量(8.30,P = 0.016)。选择IBBR的主要原因是手术操作相对简单、学习曲线短和手术时间短。辅助放疗对假体的影响、术后并发症以及患者满意度是植入物重建的主要顾虑。与延期重建相比,即刻重建中IBBR的比例更高(83.1%对62.0% χ(2)=12.522,P = 0.000)。总共10.5%(10/95)的医院报告Ⅲ至Ⅳ级包膜挛缩发生率超过10%。4.2%(4/95)的医院报告需要手术干预的感染发生率在10%至20%之间。植入物破裂发生率在6%至10%以及植入物取出率在6%至15%的医院分别为1.1%(1/95)和4.2%(4/95)。IBBR是乳房切除术后乳房重建中最常用的手术方式。然而,乳房切除术后患者中IBBR的比例仍然较低。地区经济、医院手术量、缺乏专业培训项目以及对并发症和患者满意度的顾虑是影响IBBR发展的因素。

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