中国乳腺癌乳房重建改型手术的横断面调查

doi:10.16139/j.1007-9610.2020.05.015

摘要/Abstract

摘要：

目的： 本研究旨在调查国内乳腺癌病人乳房重建术后改型手术的应用现状和影响因素。方法： 本研究运用横断面调查方法,向全国乳腺癌年手术量超过200例的110家医院发放问卷。问卷内容包括乳房重建术后改型手术（乳头重建、脂肪移植及对称性手术）的开展情况、手术方案选择及其影响,术后并发症发生等。结果： 110家受访医院中,96家（87.3%）已针对乳腺癌病人实施乳房重建手术,87家（79.1%）已开展乳房重建术后的改型手术。其中开展乳头重建的有55家（50.0%）,脂肪移植41家（37.3%）,对称性手术64家（58.2%）。同时开展2种改型手术的有31家（28.2%）,3种改型手术的有21家（19.1%）。改型手术的开展与医院所在地区经济发展水平不存在明显关联。医院乳腺癌手术量越大,进行乳头重建（P=0.01）及对称性手术（P<0.01）的比例越高,≥2种改型手术的比例越大（P≤0.01）。结论： 乳腺癌乳房重建术后改型手术已在国内受到重视。其开展规模可能受到手术规模、专业培训和病人教育的影响。

关键词: 乳腺癌, 乳房重建, 改型手术

Abstract:

Objective To investigate the application and influence factors of revisional surgery after breast reconstruction in breast cancer patients in China. Methods It is a cross-section national study by distributing questionnaires to 110 hospitals with more than 200 annual breast cancer surgeries each. The questionnaire included questions concerning the application, operative programme, influence factors and complications of revisional surgery including nipple reconstruction, fat grafting and symmetric surgery. Results A total of 96 (87.3%) in 110 hospitals had breast reconstruction and 87 (79.1%) hospitals with revisonal surgery. There was nipple reconstruction in 55 (50.0%) hospitals, fat grafting in 41 (37.3%) hospitals and symmetric surgery in 64 (58.2%) hospitals. Two types of revisonal surgery were performed in 31 (28.2%) hospitals and three types in 21 (19.1%) hospitals. The application of revisonal surgery did not have relationship significantly with local economy. There were more cases with nipple reconstruction (P=0.01) and symmetric surgery (P<0.01), as well as 2 or more than 2 types of revisonal surgery (P≤0.01) performed in hospitals which had more cases with breast cancer surgery. Conclusions Revisional surgery after breast reconstruction in breast cancer has been paid more attention in China and might be affected by the amount of breast cancer surgery in hospital, professional training and patient education.

Key words: Breast cancer, Breast reconstruction, Revisional surgery

中图分类号:

R737.9

吴可, 修秉虬, 郭瑢, 张琪, 李伦, 杨犇龙, 王嘉, 苏永辉, 季玮儒, 邵鼎轶, 邵志敏, 吴炅. 中国乳腺癌乳房重建改型手术的横断面调查[J]. 外科理论与实践, 2020, 25(05): 426-431.

WU Ke, XIU Bingqiu, GUO Rong, ZHANG Qi, LI Lun, YANG Benlong, WANG Jia, SU Yonghui, JI Weiru, SHAO Dingyi, SHAO Zhimin, WU Jiong. Revisonal surgery after breast reconstruction in breast cancer in China: a cross-sectional study[J]. Journal of Surgery Concepts & Practice, 2020, 25(05): 426-431.

图/表 2

表1

表2

参考文献 17

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	项目	医院总数	开展乳头重建	开展脂肪移植	开展对称性手术
		110	55	41	64
地区^a)	东北	11	6	5	7
	华北	20	6	7	9
	华中	11	5	4	5
	华东	38	18	17	23
	华南	13	8	2	8
	西北	7	5	2	5
	西南	10	7	4	7
χ²值			7.07	4.19	3.52
P值			0.32	0.65	0.74
人均GDP（元）^b)	<45 000	22	10	7	12
	45 000~75 000	47	24	18	28
	>75 000	41	21	16	24
χ²值			0.23	0.36	0.16
P值			0.89	0.84	0.92
是否教学医院	教学	97	51	39	60
	非教学	13	4	2	4
χ²值			2.18	3.02	4.55
P值			0.14	0.08	0.03
医院类型	专科	29	15	5	16
	综合	81	40	36	48
χ²值			0.05	6.76	0.15
P值			0.83	<0.01	0.70
年手术总量（台）	<500	53	17	17	22
	500~1 000	33	21	14	24
	>1 000	24	17	10	18
χ²值			13.43	1.19	11.72
P值			0.01	0.55	<0.01

项目		医院总数	同时开展乳头重建、对称性手术	同时开展脂肪移植、对称性手术	同时开展乳头重建、脂肪移植	同时开展 3种手术
		110	42	26	26	21
地区
	东北	11	5	3	3	3
	华北	20	4	4	4	3
	华中	11	3	1	2	1
	华东	38	13	11	11	8
	华南	13	7	2	2	2
	西北	7	5	2	2	2
	西南	10	5	3	2	2
χ²值			9.08	2.92	1.66	2.03
P值			0.17	0.82	0.95	0.92
人均GDP（2017年计,元）
	<45 000	22	8	6	4	4
	45 000~75 000	47	19	10	11	9
	>75 000	41	15	10	11	8
χ²值			0.18	0.32	0.60	0.02
P值			0.92	0.85	0.74	0.99
是否教学医院
	教学	97	39	25	25	20
	非教学	13	3	1	1	1
χ²值			1.43	2.08	2.08	1.24
P值			0.23	0.15	0.15	0.27
医院类型
	专科	29	12	5	5	5
	综合	81	30	21	21	16
χ²值			0.17	0.89	0.89	0.09
P值			0.68	0.35	0.35	0.77
年手术总量
	<500	53	11	6	5	2
	500~1 000	33	17	11	13	11
	>1 000	24	14	9	8	8
χ²值			13.43	8.73	11.71	15.54
P值			<0.01	0.01	<0.01	<0.01
整形手术年限
	>15	6	4	2	2	1
	>10~15	17	7	6	6	6
	5~10	27	17	8	7	7
	<5	55	11	8	8	5
	未进行	15	3	2	3	2
χ²值			19.13	5.61	4.30	7.93
P值			<0.01	0.23	0.37	0.09