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目的脂肪坏死是游离腹部皮瓣乳房重建术后常见的并发症之一,导致其发生的危险因素众多,且仍存在许多争议。我们通过回顾接受游离腹部皮瓣乳房重建术,且有完整术后随访记录的乳腺肿瘤患者,以了解该重建术式后重建乳房脂肪坏死的发生率,并寻找潜在的危险因素。方法收集自2010年5月至2012年10月在复旦大学附属肿瘤医院接受游离腹部皮瓣乳房重建的79位患者的资料,包括住院记录、门诊随访记录、病理及其他辅助检查结果等,评估重建乳房脂肪坏死的发生率,并通过多因素回归分析寻找潜在的危险因素。结果 80例游离腹部皮瓣乳房重建术中,共有29例(36.25%)发生脂肪坏死,其中20例脂肪坏死硬结在随访中自行缓解或消退。多因素回归分析显示,术后辅助化疗是术后发生脂肪坏死的独立预测因素,相对危险度为5.476(多因素Logistic回归模型;95%可信区间为1.902~15.766;P=0.009)。结论术后辅助化疗可显著增加游离腹部皮瓣乳房重建术后脂肪坏死的发生率。临床医师在选择乳房重建时机时,应重视辅助化疗对重建乳房的影响,在辅助化疗指征的把握、方案的拟定以及开始时间的选择上应更为慎重。
Objective Fatty necrosis is one of the common complication after free abdominal flap breast reconstruction, resulting in many risk factors and there are still many controversies. We reviewed patients with breast tumors who underwent free abdominal flap breast reconstruction and had a complete postoperative follow-up record to understand the incidence of breast fat necrosis after reconstructive surgery and to identify potential risk factors. Methods The data of 79 patients who underwent breast reconstruction with free abdominal flaps from May 2010 to October 2012 were collected, including inpatient records, outpatient follow-up records, pathology and other auxiliary examinations to assess the reconstruction The incidence of breast fat necrosis, and through multivariate regression analysis to find potential risk factors. Results Totally, 29 cases (36.25%) suffered from fat necrosis in 80 cases of free abdominal flap breast reconstruction. Among them, 20 cases of fat necrosis inducted or resolved spontaneously during follow-up. Multivariate regression analysis showed that postoperative adjuvant chemotherapy was an independent predictor of postoperative fat necrosis with a relative risk of 5.476 (multivariate Logistic regression model; 95% confidence interval 1.902 to 15.766; P = 0.009). Conclusions Postoperative adjuvant chemotherapy can significantly increase the incidence of fat necrosis after free abdominal flap reconstruction. Clinicians should pay more attention to the influence of adjuvant chemotherapy on breast reconstruction in choosing the timing of breast reconstruction. They should be more cautious about the indication of adjuvant chemotherapy, the formulation of the protocol and the selection of the starting time.