组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2023, Vol. 19 ›› Issue (5): 464-.

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假体植入乳房再造手术后各种并发症的发病时间窗及影响因素分析

  

  • 出版日期:2023-10-09 发布日期:2023-11-01

Analysis of time window and influencing factors of various complications after breast reconstruction with prosthesis implantation

  • Online:2023-10-09 Published:2023-11-01

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摘要：

目的　描述和分析乳腺癌（BC）患者行假体植入为基础的乳房重建（IBBR）后各种并发症的发病时间窗及
影响因素。方法　应用回顾性研究方法。从患者住院病历资料中提取需分析数据。对 BC 患者乳房再造术后并发症
发病时间进行描述和归纳，COX 分析探讨影响并发症发病的相关因素。结果　395 例乳房再造手术共发生急性和长
期并发症 129 例，并发症发病率 32.66%。其中，73 例患者（104 例乳房）发生≥ 1 种并发症。化疗是患者术后血肿
发病的保护因素（P<0.05）。治疗性乳房切除手术指征、组织扩张器植入假体、假体植入胸肌前平面、IBBR 术前放疗、
肥胖、吸烟是患者术后血清肿发病的危险因素（P<0.05）。IBBR 术前放疗是患者术后乳头乳晕 / 皮瓣坏死发病的危
险因素（P<0.05）。治疗性乳房切除手术指征、腋窝淋巴结清扫术是患者术后手术区域感染发病的危险因素（P<0.05）。
IBBR 术前放疗、肥胖、腋窝淋巴结清扫术、重建支持材料 Vicryl 网片是患者术后假体丢失发生的危险因素（P<0.05）。
假体植入胸肌前平面、IBBR 术前放疗、化疗、肥胖是患者术后波纹 / 褶皱发病的危险因素（P<0.05）。IBBR 术前放疗、
腋窝淋巴结清扫术是患者术后包膜挛缩发病的危险因素（P<0.05）。结论　BC 患者 IBBR 术后并发症呈现离散的时
间分布。这些发现对指导患者术后治疗、随访和临床试验设计有一定指导价值。

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Abstract:

Objective　To evaluate and analyze the time window and influencing factors of various complications in breast
cancer (BC) patients undergoing implant-based breast reconstruction (IBBR). Methods　The retrospective study method was
used in this study. Extract the data to be analyzed from the inpatient medical records. The onset time of complications after breast
reconstruction in BC patients was described and summarized, and the related factors influencing the onset of complications were
analyzed by COX. Results　There were 129 cases of acute and long-term complications in 395 cases of breast reconstruction
surgery, and the incidence rate of complications was 32.66%. Among them, 73 patients (104 breasts) had at least one complication. Chemotherapy was the protective factor of postoperative hematoma (P<0.05). The indications of therapeutic mastectomy,
tissue expander implantation, prosthesis implantation in the anterior plane of pectoral muscle, preoperative radiotherapy for
IBBR, obesity and smoking were the risk factors for postoperative seroma (P<0.05). Preoperative radiation therapy was a risk
factor for postoperative necrosis of nipple areola/skin flap in patients with IBBR (P<0.05). The indication of therapeutic mastectomy and axillary lymph node dissection were the risk factors for postoperative infection in the surgical area (P<0.05). Preoperative radiotherapy, obesity, axillary lymph node dissection, and reconstruction support material Vicryl mesh were the risk factors
for prosthetic loss in patients with IBBR (P<0.05). Prosthesis implantation in the anterior plane of pectoral muscle, preoperative
radiotherapy for IBBR, chemotherapy and obesity were the risk factors for postoperative ripple/wrinkle (P<0.05). Radiotherapy
before IBBR and axillary lymph node dissection were the risk factors of capsular contracture (P<0.05). Conclusion　Postop
erative complications of IBBR in BC patients show discrete time distribution. These findings have a certain value in guiding the
postoperative treatment, follow-up and clinical trial design of patients.

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