乳房缺失患者生活质量与乳房再造手术相关性的量化研究

摘要

目的 了解中国女性乳房缺失患者满意度及健康度状况,探讨各种影响因素对患者生活质量的影响.方法 2013年11月至2018年8月期间,对中国医学科学院整形外科医院就诊的乳房缺失患者进行横断面研究,根据纳入条件和排除条件对入组患者进行调查.利用自行设计的调查表评价患者一般情况,应用BREAST-Q乳房再造模块中文版中术前及术后量表评估其生活质量、满意度及健康度.结果 共入组139例,其中乳房再造术前患者83例,年龄(36.0±10.0)岁;乳房再造术后患者56例,年龄(33.5±10.9)岁.不同年龄、婚姻状态、教育水平、工作状态及乳房缺失病因的乳房缺失患者,生活质量差异无统计学意义.再造术后患者乳房满意度、社会心理满意度及性满意度显著高于未再造患者,差异有统计学意义(P=0.000),胸部健康度两者差异无统计学意义.应用腹部皮瓣再造患者腹部健康度低于未再造患者(P=0.007),在具体条目分析中发现与术前患者相比,腹部皮瓣再造患者主要在腹肌力量减弱的相关条目中评分较低,差异具有统计学意义(P＜0.05).结论 乳房缺失患者的生活质量与年龄、婚姻状态、教育水平、工作状态及乳房缺失病因无关,乳房再造手术可提高女性乳房满意度、社会心理及性健康度,而应用腹部皮瓣再造术后患者腹部健康度下降,手术应注意保留腹部肌肉,维持腹部形态及运动功能.%Objective To investigate the satisfaction and well-being of Chinese women with breast deficiency,and to analyze the relevant influencing factors.Methods A cross-sectional study was conducted using a self-designed questionnaire to investigate the women with breast deficiency,visiting the Plastic Surgery Hospital of Chinese Academy of Medical Sciences from November 2013 to August 2018.The BREAST-Q BR (breast reconstruction) pre-operation and post-operation modules were used to assess the quality of life.Results A total of 139 effective questionnaires were collected,including 83 patients before BR surgery and 56 post.There was no difference in quality of life in different ages,marital status,education levels,working status,and causes of breast deficiency.Mean scores of satisfaction with breasts,psychosocial well-being and sexual well-being of patients after breast reconstruction were significantly higher than those of patients without reconstruction (P=0.000),but there was no statistical difference in physical well-being-chest score.The physical well-being abdomen scores of patients with abdominal flap reconstruction was lower than that of the patients without reconstruction (P=0.007).With regard to analysis of specific items,compared with preoperative patients,patients with abdominal flap reconstruction reported lower scores in the items related to abdominal muscle weakness (P＜0.05).Conclusions The breast deficiency resulting from Poland syndrome,breast cancer and other causes,can lead to a significant decrease in quality of life.Breast reconstruction can improve satisfaction with breast,psychosocial and sexual well-being in women with breast deficiency.The abdomen well-being of patients with abdominal flap reconstruction is decreased.Therefore,more attention should be paid to retain abdominal muscles to maintain abdominal shape and motor function during operation.