乳腺切除后植入物乳房重建患者术后并发症的危险因素分析

Risk factors for postoperative complications in patients undergoing implant-based breast reconstruction after mastectomy

摘要:

背景与目的 植入物乳房重建是乳腺癌术后最常见的重建方式之一。然而，重建术后并发症的发生率不容忽视，其相关危险因素尚未明确。本研究旨在分析本中心乳腺切除并行植入物乳房重建患者术后外科相关并发症的发生情况，并探讨其潜在危险因素。方法 回顾性分析2004年5月—2022年8月在中山大学孙逸仙纪念医院接受乳腺切除并行植入物乳房重建的患者资料，根据术后是否发生外科相关并发症分组，采用Logistic回归分析并发症发生的独立危险因素。结果 共纳入545例患者、602个重建乳房，其中13.6%（82/602）出现了感染、伤口裂开/愈合不良、皮瓣或乳头乳晕坏死、植入物渗漏/破裂等术后并发症。多因素Logistic回归分析显示，接受乳头乳晕复合体（NAC）切除（OR=1.934，95% CI=1.056~3.542，P=0.033）、术后放疗（OR=2.483，95% CI=1.527~4.036，P<0.001）、植入物容量≥300 mL（OR=1.663，95% CI=1.025~2.696，P=0.039）以及主刀医生手术经验<10例（OR=1.804，95% CI=1.092~2.979，P=0.021）均为并发症的独立危险因素。结论 NAC切除、放疗、大容量植入物以及术者经验不足是植入物乳房重建术后外科相关并发症的重要危险因素，术前充分评估及术式选择应予重视。

Abstract:

Background and Aims Implant-based breast reconstruction is one of the most common reconstructive approaches after mastectomy for breast cancer. However, the incidence of postoperative complications remains significant, and the associated risk factors have not been fully elucidated. This study aimed to analyze the incidence of surgical complications following implant-based breast reconstruction in patients undergoing mastectomy at our center and to identify potential risk factors.Methods A retrospective analysis was conducted on patients who underwent mastectomy and implant-based breast reconstruction at Sun Yat-sen Memorial Hospital between May 2004 and August 2022. Patients were grouped according to the presence or absence of postoperative surgical complications, and multivariate Logistic regression was used to identify independent risk factors.Results A total of 545 patients with 602 reconstructed breasts were included. Surgical complications occurred in 13.6% (82/602) of the cases, including infection, wound dehiscence/poor healing, flap or nipple-areola necrosis, and implant leakage/rupture. Multivariate analysis revealed that nipple-areola complex resection (OR=1.934, 95% CI=1.056-3.542, P=0.033), postoperative radiotherapy (OR=2.483, 95% CI=1.527-4.036, P<0.001), implant volume ≥300 mL (OR=1.663, 95% CI=1.025-2.696, P=0.039), and surgeon experience with fewer than 10 cases (OR=1.804, 95% CI=1.092-2.979, P=0.021) were all independent risk factors for complications.Conclusion NAC resection, radiotherapy, large implant volume, and limited surgical experience are important independent risk factors for postoperative surgical complications following implant-based breast reconstruction. Thorough preoperative evaluation and appropriate surgical planning are essential to minimize risks.