乳腺癌改良根治术后即刻乳房重建后放疗的临床效果分析

摘要

目的：研究乳腺癌改良根治术后即刻行乳房重建后行放疗的可行性及其对美容效果的影响。方法2009年8月～2014年5月本院为40例女性乳腺癌患者行乳腺癌改良根治术+即刻乳房重建术，其中15例患者术后行放疗，通过资料回顾，分析即刻乳房重建后行放疗的可行性及其对美容效果的影响。结果40例乳房重建均成功，15例行即刻乳房重建后放疗的患者中，发生干性脱皮2例，湿性脱皮1例，4例患者有不同程度的皮肤色素沉着；3例假体重建的患者发生不同程度的假体挛缩；3例行自体组织重建的患者发生转移皮瓣的挛缩，乳房轻度缩小。在25例未行放疗即刻乳房重建后的患者中，优良率为84%（21/25），在15例行即刻乳房重建后放疗的患者中，优良率为73%（11/15）。所有患者对于美容效果的可接受度为92.5%。随访未出现局部复发、远处转移及死亡病例。结论放疗增加了假体挛缩等并发症的发生率，但美容效果及患者的满意度仍然较高；另外放疗对自体组织重建的总体满意度和美容效果没有显著影响；对于乳房切除即刻乳房重建后需行放疗的患者，更适合选择自体组织乳房重建。%Objective To observe the feasibility and breast cosmetic results of radiotherapy after immediate breast reconstruction following modiifed radical mastectomy. Methods 40 female breast cancer patients underwent modified radical mastectomy plus immediate breast reconstruction were enrolled into this study from August 2009 to May 2014. Of the 40 patients, 15 received radiotherapy after immediate breast reconstruction. Through retrospective analysis, we analyzed the feasibility of radiotherapy after immediate breast reconstruction and its impact on breast cosmetic results.Results All the 40 cases of breast reconstruction were successful. Among 15 patients who received radiotherapy, 2 patients had complication of dry desquamation, 1 patient had complication of moist desquamation, and 4 patients had complication of varying degrees of skin pigmentation. Besides, 3 patients with breast prosthesis reconstruction had complication of varying degrees of prosthesis contracture, and 3 patients with autologous tissue reconstruction had complication of metastatic lfap mild narrowing. In 25 patients with immediate breast reconstruction after radiotherapy, the excellent and good rate was 84%(21/25), and the excellent and good rate was 73% (11/15) in 15 patients who underwent immediate breast reconstruction. For all patients with immediate breast reconstruction, the acceptability of cosmetic results was 92.5%. What’s more, no local recurrence, distant metastases and deaths had been observed. Conclusion Radiotherapy increased the incidence of complications of immediate breast reconstruction, such as prosthesis contracture, but the cosmetic results and patients’ satisfaction remain high. Addition of radiotherapy did not signiifcantly affect the overall satisfaction and cosmetic results of patients with autologous tissue reconstruction. Thus, for patients who need radiotherapy after immediate breast reconstruction, autologous tissue breast reconstruction is a more suitable choice.