摘要目的 研究手术时机、手术方式以及手术年龄对乳房再造患者的满意度和生活质量的影响.方法 回顾性分析2004年8月至2017年7月由同一术者在北京大学人民医院和中国医学科学院整形外科医院完成的102例乳房再造患者的资料,符合入选标准者共54例,根据手术时机分为即刻组与延期组,根据手术方式分为腹部组与其他组,根据患者年龄分为低龄组与高龄组.评估指标为:(1)术后并发症发生率;(2)基于BREAST-Q量表评估术前和术后患者的乳房满意度、心理健康度、胸部健康度、腹部健康度、性健康度,以及术后结局满意度、治疗经历满意度、服务满意度.应用SPSS 20.O统计软件对数据进行处理分析,若数据符合正态分布,采用独立样本t检验,若不符合,采用非参数秩和检验.比较组间差异时采用协方差分析.结果 各组并发症发生率分别为即刻组9.1％(1/11),延期组16.3％(7/43),腹部组14.7％ (5/34),其他组15.0％ (3/20),低龄组13.6％(3/22),高龄组15.6％(5/32),在不同分组方式下,并发症的发生率在各组间差异均无统计学意义(P＞0.05).即刻组的乳房满意度、心理健康度以及性健康度术后评分均显著高于延期组,差异具有统计学意义(P值分别为0.026、0.000、0.001);腹部组在术后胸部健康度评分显著高于其他组,而其腹部健康度较术前明显下降,差异具有统计学意义(P值分别为0.020、0.000);高龄组仅腹部健康度明显低于低龄组,差异具有统计学意义(P=0.010).结论 并发症的发生率各组内比较,差异均无统计学意义.乳腺癌术后进行乳房再造术可以显著提高患者生活质量和满意度.即刻乳房再造术可以在一定程度上减少乳房缺失对患者心理及生理方面的影响,且使患者具有更高的术后满意度.应用腹部皮瓣行乳房再造术可使患者具有更高的胸部健康度,但会降低腹部健康度.高龄患者进行乳房再造术虽然会降低腹部健康度,但仍可获得较高的术后满意度.

abstractsObjective This is a study to evaluate complication rate,satisfaction and quality of life after breast reconstruction under different classifications.The classification criteria are the timing of operation,surgical procedures,and patients'age.Methods By reviewing the surgical cases from August 2004 to June 2018,the authors summarized the data of 102 patients with breast reconstruction of the same surgeon in Peking University People's Hospital and Plastic Surgery Hospital (Institute) CAMS PUMC.Fifty-four patients who met the inclusion criteria and completed the BREAST-Q breast reconstruction module scale,were divided into immediate group or delayed group,according to the timing of operation;divided into abdomen group or other procedures group,according to the surgical procedure;and divided into the young patients'group or senior patients'group according to age.The index were (1) postoperative complication rate,(2) satisfaction with breasts,psychosocial well-being,physical well-being of chest and abdomen,sexual well-being,satisfaction with outcome,satisfaction with information,satisfaction with care (based on the BREAST-Q scale).Results Complication rate was 9.1％ (1/11) in the immediate group,16.3％(7/43) in the delayed group,14.7％ (5/34) in the abdomen group,15.0％ (3/20) in other procedures group,13.6％(3/22) in the young patients'group,and 15.6％ (5/32) in the senior patients' group.There was no significant difference in the incidence of complications (P＞0.05).The postoperative scores of satisfaction with breasts,psychological well-being and sexual well-being were significantly higher in the immediate group than in the delayed group(P =0.026,P＜0.001 and P =0.001,respectively).The score of postoperative physical well-being of chest was significantly higher in the abdomen group than other procedures group(P=0.020).The score physical well-being of abdomen was lower compared with the preoperative in the abdomen group (P＜0.001).The score of physical well-being of abdomen was lower in the senior patients' group than that of the young patients' group (P =0.010).Conclusions The complication incidence of breast reconstruction patients was similar among different groups.The breast reconstruction surgery can significantly improve satisfaction and quality of life of patients.To some extent,immediate breast reconstruction can reduce the psychological and physiological effects of breast loss on patients,leading to higher postoperative satisfaction.Breast reconstruction with abdominal flaps can provide patients with better chest health but poor abdomen health.Although elderly patients undergoing breast reconstruction will have poor physical well-being of abdomen,they can still achieve higher satisfaction of operation.