Zhang C, Sun H H, Li J, Jiang H C, Guan S, Wang X, Wen B, Ouyang T, Li X R, Geng C Z, Yin J
Department of Breast Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Department of General Surgery, Beiyuan Street Community Health Service Center, Beijing 101100, China.
Zhonghua Wai Ke Za Zhi. 2020 Feb 1;58(2):105-109. doi: 10.3760/cma.j.issn.0529-5815.2020.02.006.
To summarize the status of immediate breast reconstruction (IBR) after mastectomy in Beijing City, Tianjin City and Hebei Province. A retrospective analysis was made on the data of 382 cases with breast cancer who were treated and followed up successfully with immediate breast reconstruction after mastectomy from January 2012 to December 2016 in Beijing City, Tianjin City and Hebei Province. Clinic data of the followed-up 382 cases (all female, age (38.5±4.2) years (range: 24 to 70 years)), including general information, tumor information, sugery methods, and treatments after surgery were collected. The survival status, metastasis,complications and prognosis were followed up. Cosmetic effcet was evalated by Harris method, and life quality by Functional Assessment of Cancer Therapy-Breast scale (FACT-B). χ(2) test was used to compare the difference between year 2012 and year 2013 to 2016. Bonferroni method was used to correct the inspection level, which was 0.05/10=0.005. The trend of IBR rate (ratio of IBR to modified radical mastectomy) from 2013 to 2016 was analyzed by trend χ(2) test. There was 46 cases in stage 0, 152 cases in stage Ⅰ, 165 cases in stage Ⅱ, 19 cases in stage Ⅲ. Twenty-five cases was treated by neoadjuvant chemotherapy, 231 by chemotherapy and 35 by radiotherapy. The proportion of implant reconstruction was 48.7% (186/382), more than expanded of 21.5% (82/382), with latissimus dorsi of 12.0% (46/382), TRAM of 8.9% (34/382), DIEP of 2.1% (8/382), and latissimus plus implant of 6.8% (26/382). According to the Harris standard, the excellent and good rate of the cosmetic effect of the reconstructed breast was 93.7%. The score of FACT-B was 108.20±16.9 (range: 67 to 144) 1 year postoperatively. Compared with 2012, the IBR rate was significant increased, till 2015, the IBR rate was 153/10 000 cases (χ(2)=47.028, 0.000). There is a significant increase on IBR rate in Beijing City, Tianjin City and Hebei province by year. Most of cases received IBR is stage Ⅰ to Ⅱ. Implant reconstruction is the main reconstructive method. Postoperative cosmetic effects and quality of life are both meet patients' demon.
总结北京市、天津市和河北省乳房切除术后即刻乳房重建（IBR）的现状。对2012年1月至2016年12月在北京市、天津市和河北省成功接受乳房切除术后即刻乳房重建治疗并随访的382例乳腺癌患者的数据进行回顾性分析。收集了随访的382例患者（均为女性，年龄（38.5±4.2）岁（范围：24至70岁））的临床资料，包括一般信息、肿瘤信息、手术方法及术后治疗情况。对生存状况、转移情况、并发症及预后进行随访。采用Harris法评估美容效果，采用癌症治疗功能评价量表-乳腺（FACT-B）评估生活质量。采用χ²检验比较2012年与2013年至2016年的差异。采用Bonferroni法校正检验水准，为0.05/10 = 0.005。采用趋势χ²检验分析2013年至2016年IBR率（IBR与改良根治术的比例）的变化趋势。0期46例，Ⅰ期152例，Ⅱ期165例，Ⅲ期19例。25例接受新辅助化疗，231例接受化疗，35例接受放疗。植入物重建的比例为48.7%（186/382），扩张器重建的比例为21.5%（82/382），背阔肌肌皮瓣重建的比例为12.0%（46/382），横行腹直肌肌皮瓣（TRAM）重建的比例为8.9%（34/382），腹壁下动脉穿支皮瓣（DIEP）重建的比例为2.1%（8/382），背阔肌肌皮瓣加植入物重建的比例为6.8%（26/382）。根据Harris标准，重建乳房美容效果的优良率为93.7%。术后1年FACT-B评分108.20±16.9（范围：67至144）。与2012年相比，IBR率显著提高，至2015年，IBR率为153/10000例（χ² = 47.028，P = 0.000）。北京市、天津市和河北省的IBR率逐年显著提高。接受IBR的患者大多为Ⅰ至Ⅱ期。植入物重建是主要的重建方法。术后美容效果和生活质量均符合患者需求。
