异种脱细胞真皮与钛化聚丙烯网片在术后即刻乳房重建中的效果对比
|
摘要
目的:探讨异种脱细胞真皮(xenogenic acellular dermal matrix,XADM)与新型钛化聚丙烯网片(titanium-coated polypropylene mesh,TCPM)在乳腺癌切除术后即刻乳房重建中的应用价值,并对比两种材料临床效果及术后并发症。方法:2017年1月至2018年9月确诊为乳腺癌并需要采用假体联合补片进行即刻乳房重建的患者40例纳入本研究。患者分为两组:A组使用异种脱细胞真皮(n=21),B组使用钛化聚丙烯网片(n=19),所有患者均为单侧手术,两组间一般资料差异无统计学意义,具有可比性。术后对比两组患者总引流量、引流管拔除时间、并发症发生情况。患者随访3～24个月,平均11个月。结果:A组总引流量平均为(658.29±72.82) mL,B组平均为(576.58±92.06) mL,差异有统计学意义(P<0.05)。A组平均引流拔管时间为(12.57±2.01) d,B组为(10.21±1.87) d,差异有统计学意义(P<0.05)。两组均未出现皮瓣坏死、乳头乳晕坏死、假体外露、补片暴露、包膜挛缩等并发症。结论:异种脱细胞真皮与新型钛化聚丙烯网片用于乳腺癌切除术后即刻乳房重建的手术方式均简单方便,易于操作和推广,对患者均安全有效、创伤小、恢复快。
Objective: To explore the application of xenogenic acellular dermal matrix and titanium-coated polypropylene mesh in immediate breast reconstruction after breast cancer resection and to compare their clinical effects and postoperative complications. Methods: From Jan. 2017 to Sep. 2018, 40 patients diagnosed with breast cancer undergoing breast resection and requiring immediate patch-based breast reconstruction were enrolled. Patients were divided into two groups: patients in group A were reconstructed with xenogenic acellular dermal matrix(n=21), patients in group B were reconstructed with titanium-coated polypropylene mesh(n=19). All patients underwent unilateral surgery. There was no significant differences in the general data between the two groups. Total drainage volume, duration of drainage, and complications were recorded after operation. Patients were followed up for 3 to 24 months, with an average of 11 months. Results: The mean total drainage volume of patients in group A was(658.29±72.82) mL, and its in group B was(576.58±92.06) mL, with significant difference between the two groups(P<0.05). The mean time of duration of drainage in group A was(12.57±2.01) d, while that in group B was(10.21±1.87) d. The difference was statistically significant(P<0.05). There was no case of skin flap necrosis, nipple areola necrosis, prosthesis exposure, patch exposure, or capsular contracture in both groups. Conclusions: Xenogenic acellular dermal matrix and titanium-coated polypropylene mesh implantation are easy to operate for immediate breast reconstruction. The two materials can be used for a less invasive and faster healing treatment.
Objective: To explore the application of xenogenic acellular dermal matrix and titanium-coated polypropylene mesh in immediate breast reconstruction after breast cancer resection and to compare their clinical effects and postoperative complications. Methods: From Jan. 2017 to Sep. 2018, 40 patients diagnosed with breast cancer undergoing breast resection and requiring immediate patch-based breast reconstruction were enrolled. Patients were divided into two groups: patients in group A were reconstructed with xenogenic acellular dermal matrix(n=21), patients in group B were reconstructed with titanium-coated polypropylene mesh(n=19). All patients underwent unilateral surgery. There was no significant differences in the general data between the two groups. Total drainage volume, duration of drainage, and complications were recorded after operation. Patients were followed up for 3 to 24 months, with an average of 11 months. Results: The mean total drainage volume of patients in group A was(658.29±72.82) mL, and its in group B was(576.58±92.06) mL, with significant difference between the two groups(P<0.05). The mean time of duration of drainage in group A was(12.57±2.01) d, while that in group B was(10.21±1.87) d. The difference was statistically significant(P<0.05). There was no case of skin flap necrosis, nipple areola necrosis, prosthesis exposure, patch exposure, or capsular contracture in both groups. Conclusions: Xenogenic acellular dermal matrix and titanium-coated polypropylene mesh implantation are easy to operate for immediate breast reconstruction. The two materials can be used for a less invasive and faster healing treatment.
引文
[ 1 ] JANKOWSKA M.Sexual functioning in young women in the context of breast cancer treatment[J].Rep Pract Oncol Radiother,2013,18(4):193-200.
[ 2 ] ELDER E E,BRANDBERG Y,BJ?RKLUND T,et al.Quality of life andpatient satisfaction in breast cancer patients after immediate breast reconstruction:a prospective study[J].Breast,2005,14 (3):201-208.
[ 3 ] HOWARD M A,POLO K,PUSIC A L,et al.Breast cancer local recurrence after mastectomy and tram flap reconstruction:incidence and treatment options[J].Plast Reconstr Surg,2006,117 (5) :1381-1386.
[ 4 ] SUE G R,LANNIN D R,AU A F,et al.Factors associated with decision to pursue mastectomy and breast reconstruction for treatment of ductal carcinoma in situ of the breast[J].Am J Surg,2013,206(5):682-685.
[ 5 ] JAGSI R,JIANG J,MOMOH A O,et al.Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States[J].J Clin Oncol,2014,32(9):919-926.
[ 6 ] BRENNAN M E,SPILLANE A J.Uptake and predictors of post-mastectomy reconstruction in women with breast malignancy-Systematic review[J].Eur J Surg Oncol,2013,39(6):527-541.
[ 7 ] JAGSI R,JIANG J,MOMOH A O,et al.Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States[J].J Clin Oncol,2014,32( 9):919-926.
[ 8 ] NAHABEDIAN M Y.Acellular dermal matrices in primary breast reconstruction:principles,concepts,and indications[J].Plast Reconstr Surg,2012,130(5 Suppl 2) :44S-53S.
[ 9 ] CASELLA D,BERNINI M,BENCINI L,et al.TiLoop○R Bra mesh used for immediate breast reconstruction:comparison of retropectoraland subcutaneous implant placement in a prospective single-institution series[J].Eur J Plast Surg,2014,37(11):599-604.
[10] DIETERICH M,PAEPKE S,ZWIEFEL K,et al.Implant-based breast reconstruction using a titanium-coated polypropylene mesh (TiLOOP Bra):a multicenter study of 231 cases[J].Plast Reconstr Surg,2013,132(1):8e-19e.
[11] 2015 Plastic Surgery Statistics Report (data obtained from the ASPS National Clearing House of Plastic Surgery Procedural Statistics)[EB/OL].[2016].https://www.plasticsurgery.Org
[12] GSCHWANTLER-KAULICH D,SCHRENK P,BJELICRADISIC V,et al.Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction-A prospective randomized trial[J].Eur J Surg Oncol,2016,42(5):665-671.
[13] MC CARTHY C M,LEE C N,HALVORSON E G,et a1.The use of a cellular dermal matrices in two-stage expander/ implant reconstruction:A muhicenter,blinded,randomized controlled trial[J].Plast Reconstr Surg,2012,130(5 Suppl 2):57S-66S.
[14] KARL H,BREUING,STEPHEN M,et al.Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings[J].Ann Plas Surg,2005,55(3):232-239.
[15] BRZEZIENSKI M A,MOOTY R C.Classification and management of seromas in immediate breast reconstruction using the tissue expander and acellular dermal matrix technique[J].Ann Plas Surg,2013,70(5):488-492.
[16] LOGAN ELLIS H,ASAOLU O,NEBO V,et al.Biological and synthetic mesh use in breast reconstructive surgery:a literature review[J].World J Surg Oncol,2016,14(1):121.
[17] GASTER R S,BERGER A J,MONICA S D,et al.Histologic analysis of fetal bovine derived acellular dermal matrix in tissue expander breast reconstruction[J].Ann Plas Surg,2013,70(4):447-453.
[18] WU P S,WINOCOUR S,JACOBSON S R.Red breast syndrome:A review of available literature[J].Aesthetic Plast Surg,2015,39(2):227-230.
[19] PETIT J Y,BOTTERI E,LOHSIRIWAT V,et al.Locoregional recurrence risk after lipofilling in breast cancer patients[J].Ann Oncol,2011,23( 3):582-588.
[20] PETIT J Y,MAISONNEUVE P,ROTMENSZ N,et al.Fat grafting after invasive breast cancer:A matched case-control study[J].Plast Reconstr Surg,2017,139(6) :1292-1296.
[ 2 ] ELDER E E,BRANDBERG Y,BJ?RKLUND T,et al.Quality of life andpatient satisfaction in breast cancer patients after immediate breast reconstruction:a prospective study[J].Breast,2005,14 (3):201-208.
[ 3 ] HOWARD M A,POLO K,PUSIC A L,et al.Breast cancer local recurrence after mastectomy and tram flap reconstruction:incidence and treatment options[J].Plast Reconstr Surg,2006,117 (5) :1381-1386.
[ 4 ] SUE G R,LANNIN D R,AU A F,et al.Factors associated with decision to pursue mastectomy and breast reconstruction for treatment of ductal carcinoma in situ of the breast[J].Am J Surg,2013,206(5):682-685.
[ 5 ] JAGSI R,JIANG J,MOMOH A O,et al.Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States[J].J Clin Oncol,2014,32(9):919-926.
[ 6 ] BRENNAN M E,SPILLANE A J.Uptake and predictors of post-mastectomy reconstruction in women with breast malignancy-Systematic review[J].Eur J Surg Oncol,2013,39(6):527-541.
[ 7 ] JAGSI R,JIANG J,MOMOH A O,et al.Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States[J].J Clin Oncol,2014,32( 9):919-926.
[ 8 ] NAHABEDIAN M Y.Acellular dermal matrices in primary breast reconstruction:principles,concepts,and indications[J].Plast Reconstr Surg,2012,130(5 Suppl 2) :44S-53S.
[ 9 ] CASELLA D,BERNINI M,BENCINI L,et al.TiLoop○R Bra mesh used for immediate breast reconstruction:comparison of retropectoraland subcutaneous implant placement in a prospective single-institution series[J].Eur J Plast Surg,2014,37(11):599-604.
[10] DIETERICH M,PAEPKE S,ZWIEFEL K,et al.Implant-based breast reconstruction using a titanium-coated polypropylene mesh (TiLOOP Bra):a multicenter study of 231 cases[J].Plast Reconstr Surg,2013,132(1):8e-19e.
[11] 2015 Plastic Surgery Statistics Report (data obtained from the ASPS National Clearing House of Plastic Surgery Procedural Statistics)[EB/OL].[2016].https://www.plasticsurgery.Org
[12] GSCHWANTLER-KAULICH D,SCHRENK P,BJELICRADISIC V,et al.Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction-A prospective randomized trial[J].Eur J Surg Oncol,2016,42(5):665-671.
[13] MC CARTHY C M,LEE C N,HALVORSON E G,et a1.The use of a cellular dermal matrices in two-stage expander/ implant reconstruction:A muhicenter,blinded,randomized controlled trial[J].Plast Reconstr Surg,2012,130(5 Suppl 2):57S-66S.
[14] KARL H,BREUING,STEPHEN M,et al.Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings[J].Ann Plas Surg,2005,55(3):232-239.
[15] BRZEZIENSKI M A,MOOTY R C.Classification and management of seromas in immediate breast reconstruction using the tissue expander and acellular dermal matrix technique[J].Ann Plas Surg,2013,70(5):488-492.
[16] LOGAN ELLIS H,ASAOLU O,NEBO V,et al.Biological and synthetic mesh use in breast reconstructive surgery:a literature review[J].World J Surg Oncol,2016,14(1):121.
[17] GASTER R S,BERGER A J,MONICA S D,et al.Histologic analysis of fetal bovine derived acellular dermal matrix in tissue expander breast reconstruction[J].Ann Plas Surg,2013,70(4):447-453.
[18] WU P S,WINOCOUR S,JACOBSON S R.Red breast syndrome:A review of available literature[J].Aesthetic Plast Surg,2015,39(2):227-230.
[19] PETIT J Y,BOTTERI E,LOHSIRIWAT V,et al.Locoregional recurrence risk after lipofilling in breast cancer patients[J].Ann Oncol,2011,23( 3):582-588.
[20] PETIT J Y,MAISONNEUVE P,ROTMENSZ N,et al.Fat grafting after invasive breast cancer:A matched case-control study[J].Plast Reconstr Surg,2017,139(6) :1292-1296.