Franchelli S, Leone M S, Passarelli B, Perniciaro G, Capelli M, Baracco G, Alberisio A, Santi P L
Servizio di Chirurgia Plastica e Ricostruttiva, Istituto Nazionale per la Ricerca sul Cancro, Genova.
Minerva Chir. 1995 May;50(5):481-8.
Breast reconstruction has become an available option for most patients undergoing mastectomy: in fact many authors agree that breast reconstruction does not interfere with possible therapies and improves the quality of life of women. The aim of the study was to evaluate the psychological adjustment of patients who had immediate or delayed reconstruction using 2 different methods: implants and autologous tissues. The study population (115 patients) was derived from patients who underwent breast reconstruction in the period January 1988-December 1991, in follow-up at the Department of Plastic and Reconstructive Surgery; no patient was undergoing psychological therapy. 58 patients underwent breast reconstruction using implants and 57 using Transverse Rectus Abdominis Myocutaneous Flap (TRAMF). Informations were gathered, including the patient's age, the number of offspring, the marital status, the scholastic education, the job and the relapse between mastectomy and reconstruction. The psychological instruments consisted in three standardized self-administered questionnaires: Psychological Distress Inventory (PDI), State Trait Anxiety Inventory form Y (STAI), Eysenk Personality Inventory (EPQ-R). These tests were chosen to gauge the psychological distress, such anxiety, anger, depression and psychosocial maladjustment. To better perform the changes of body image after breast reconstruction, women were requested to answer three more specific questions about the sexual desire, physical image and social relationships. The 102 patients assessed in this study indicate low incidence of psychological distress and adaptive coping strategies. Impairment was reported, regarding body image, by patients undergoing delayed reconstruction; in these patients higher scores in distress tests were observed.
事实上，许多作者都认同乳房重建不会干扰可能的治疗方法，并且能改善女性的生活质量。本研究的目的是评估采用两种不同方法（植入物和自体组织）进行即刻或延迟重建的患者的心理调适情况。研究人群（115名患者）来自1988年1月至1991年12月期间在整形与重建外科接受乳房重建的患者，且均在该科室接受随访；没有患者正在接受心理治疗。58名患者采用植入物进行乳房重建，57名患者采用腹直肌横形肌皮瓣（TRAMF）进行乳房重建。收集了包括患者年龄、子女数量、婚姻状况、学历、工作以及乳房切除与重建之间的间隔时间等信息。心理评估工具包括三份标准化的自我管理问卷：心理困扰量表（PDI）、Y型状态特质焦虑量表（STAI）、艾森克人格问卷修订版（EPQ-R）。选择这些测试来衡量心理困扰，如焦虑、愤怒、抑郁和心理社会适应不良情况。为了更好地评估乳房重建后身体形象的变化，要求女性回答另外三个关于性欲、身体形象和社会关系的更具体问题。本研究中评估的102名患者显示心理困扰和适应性应对策略的发生率较低。接受延迟重建的患者报告了身体形象方面的损害；在这些患者中观察到在困扰测试中的得分更高。
