Kroll S S, Evans G R, Reece G P, Miller M J, Robb G, Baldwin B J, Schusterman M A
Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, USA.
Plast Reconstr Surg. 1996 Feb;97(2):364-72. doi: 10.1097/00006534-199602000-00014.
Resource costs, as measured by hours of time in the operating room, days of stay in the hospital, and other costs of care, were evaluated for 240 patients who underwent mastectomy with immediate breast reconstruction using either TRAM flaps or breast implants at The University of Texas M. D. Anderson Cancer Center. To make costs comparable, only patients who completed reconstruction of the nipple were included. As expected, the initial resource costs of implant-based reconstruction were much lower than those of TRAM flap reconstruction. After correcting for patients whose reconstructions were unsuccessful and including the costs of surgery subsequent to the initial reconstruction, however, the cost advantage of implant-based reconstruction disappeared. If current trends continue, it is likely that with increased follow-up, the long-term resource costs of implant-based reconstructions will continue to increase, while those of autogenous tissue reconstructions will not. Autogenous breast reconstruction with the TRAM flap therefore appears to be more cost-effective, in terms of time as well as dollars, in the long run than reconstruction based on prosthetic implants.
以手术室时间、住院天数及其他护理成本衡量的资源成本，在得克萨斯大学MD安德森癌症中心，对240例行乳房切除术并即刻乳房重建的患者进行了评估，这些患者使用了横行腹直肌肌皮瓣（TRAM瓣）或乳房植入物进行重建。为使成本具有可比性，仅纳入完成乳头重建的患者。正如预期的那样，基于植入物的重建的初始资源成本远低于TRAM瓣重建的成本。然而，在对重建不成功的患者进行校正并计入初次重建后的手术成本后，基于植入物的重建的成本优势消失了。如果当前趋势持续下去，随着随访时间的增加，基于植入物的重建的长期资源成本可能会继续增加，而自体组织重建的成本则不会。因此，从长远来看，就时间和金钱而言，采用TRAM瓣进行自体乳房重建似乎比基于假体植入物的重建更具成本效益。
