论文部分内容阅读
目的乳腺癌根治手术的过程中,近年来采用了许多皮瓣游离方法,在皮瓣厚薄方面也有不同的探讨,大家力图使得手术做得彻底、干净,往往担心厚皮瓣可能造成肿瘤残留,影响术后的局部区域复发及远处转移率,而忽视乳腺癌术后的并发症。本文进一步探讨皮瓣厚薄不同对根治性乳癌术后疗效及并发症的影响。方法采取随机分组的方法,将收治的准备行根治性手术的乳癌患者随机分成薄皮瓣手术组、中厚皮瓣手术组进行对照研究。2组患者除了在手术过程中采用不同的皮瓣游离方法即厚薄不同外,其余相同。结果薄皮瓣游离组87例中,局部区域复发5例,复发率5.7%;5年生存62例,5年生存率71.3%;皮瓣坏死17例,严重坏死的6例;发生局部区域积液39例,出现区域积液的持续时间延迟的22例。中厚皮瓣游离组99例中,局部区域复发6例,复发率6.1%;5年生存75例,5年生存率75.8%;皮瓣坏死4,严重坏死的1例;发生局部区域积液21例,出现区域积液的持续时间延迟的6例。2组远处转移及局部区域复发率差异无统计学意义,而皮瓣的局部坏死率以及局部区域积液发生率、区域积液的持续时间差异均有统计学意义,P<0.05。结论皮瓣厚薄不同对根治性乳癌术后远处转移及局部区域复发率无明显影响,中厚皮瓣能有效降低皮瓣的局部坏死率以及局部区域积液发生率,缩短区域积液的持续时间。
Purpose In the course of radical operation of breast cancer, many flap free methods have been adopted in recent years, and there are also different discussions on flap thickness. Everyone tries to make the operation completely and cleanly, and often fears that the thick flap may cause tumor residue and affect Postoperative local regional recurrence and distant metastasis, while ignoring the postoperative complications of breast cancer. This article further explore the skin flap thickness of the curative effect and complications of radical surgery. Methods A randomized grouping method was adopted to divide the breast cancer patients who underwent radical surgery into thin skin flap surgery group and moderate skin flap surgery group. In addition to the two groups of patients in the course of surgery using different flap free method that is different thickness, the rest the same. Results In the 87 cases with free flap, 5 cases were locally recurred in 5 cases, the recurrence rate was 5.7%, 62 cases in 5 years and 71.3% in 5 years, 17 cases in necrosis of skin flap and 6 cases in severe necrosis. Fluid in 39 cases, there was regional delay in the duration of 22 cases of fluid. In the 99 cases with free flap, there were 6 cases of recurrence in local area, with a recurrence rate of 6.1%; 5 years of survival in 75 cases and 5-year survival rate of 75.8%; 4 cases of necrosis of the flap and 1 case of severe necrosis; 21 cases, regional effusion occurred in the delay of 6 cases. There was no significant difference in the distant metastasis and regional recurrence between the two groups. The local necrosis rate of the flap, the incidence of effusion in the local area and the duration of regional effusion were all statistically significant (P <0.05). Conclusion Different skin flap thickness have no significant effect on the postoperative distant metastasis and local recurrence rate of radical breast cancer. The medium-thick flap can effectively reduce the local necrosis rate of flap and the incidence of effusion in local area and shorten the regional effusion time.