植入物乳房重建一步法和二步法临床对比研究

目的:探讨即刻乳房假体重建（一步法）和应用扩张器的假体重建（二步法）两种不同手术方式在术后并发症、美容效果和成本效益的差异。方法:回顾性分析我院乳腺外科2015年5月至2018年5月收治的285例乳腺癌植入物重建患者，依据手术方式不同分为一步法组（145例）和二步法组（140例），比较两组患者临床资料的差异。结果:一步法组术后出血发生率（6.8%）高于二步法组（1.4%），差异有统计学意义（P=0.021）。一步法组术后伤口皮瓣坏死率（6.2%）高于二步法组（1.4%），差异有统计学意义（P=0.036）。二步法组乳房满意度评分（81.5±7.1）分高于1步法组（78.6±6.2）分，差异有统计学意义（P=0.035）。二步法组住院总花费（80 334.8±6 149.8）元高于一步法组（60 966.5±5 544.9）元，差异有统计学意义（P=0.049）。二步法组住院天数（34.3±3.2）天多于一步法组（17.5±3.9）天，差异有统计学意义（P=0.014）。结论:在植入物乳房重建两种手术方式中，二步法相较于一步法，其并发症少，美容效果好，但在成本效益上并不优于一步法。

Clinical comparative study of one-step and two-step methods for implant breast reconstruction

Objective:To investigate the difference of postoperative complications,cosmetic effects and cost-effectiveness between two different surgical methods:Immediate breast reconstruction(one-step method)and prosthesis reconstruction with dilator(two-stepmethod).Methods:A retrospective analysis of 285 patients with the reconstruction of breast cancer implants in our hospital from May 2015 to May 2018 was divided into one-step group(145 cases)and two-stepmethod group(140 cases)according to different surgical methods.Clinical data was compared between the two groups.Results:The incidence of postoperative bleeding in the one-step group was 6.8%which was significantly higher than that in the two-step group(1.4%)(P=0.021).The rate of wound flap necrosis(6.2%)was significantly higher in the one-step group than in the two-step group(1.4%)(P=0.036).The breast satisfaction score of the two-step group(81.5±7.1)points was significantly higher than that of the one-step group(78.6±6.2)points,P=0.035.The total cost of hospitalization in the two-step group(80334.8±6149.8)yuan was significantly higher than that in the one-step group(60966.5±5544.9)yuan,P=0.049.The length of hospital stay in the two-step group(34.3±3.2)days was more than one-step group(17.5±3.9)days,respectfully,P=0.014.Conclusion:The two-step method has fewer complications and better cosmetic effect than the one-step method,but it is not superior to the one-step method in cost-effectiveness within the two surgical methods of implant breast reconstruction.