| Background Breast cancer is one of the most common malignant tumor in women,the incidence rate increased year by year,And the age of onset was younger.It’s a serious threat to the health of women.Surgery is an effective therapy for breast cancer,But in the operation of ipsilateral breast resection.Change the form after surgery need to withstand greater physical and mental trauma.Modern women in breast cancer patients after pain relief,More attention to the recovery of their physical and mental health.In recent years,with the progress of medical technology,Breast reconstruction can meet the needs of patients with breast cancer after surgery to restore the perfect body.Since the end of last century,breast reconstruction technology has made great progress,multiple operation mode has been used for breast reconstruction.Commonly used with transverse rectus abdominis musculocutaneous,the inferior epigastric artery perforator flap,the inferior gluteal artery perforator flap,latissimus dorsi muscle flap,the superior gluteal artery perforator flap and gluteal musculocutaneous flap can effectively restore the appearance of breast.As an important secondary sexual characteristics of women,the breast has a wealth of sensory nerve endings,can respond to external stimuli.But at present,it is difficult to restore the feeling of breast reconstruction for patients with breast reconstruction surgery.Loss of nerve control of the reconstruction of the breast is easy to damage and difficult to restore.In addition,patients with no sense of the reconstruction of the breast is difficult to accept.Therefore,it is important to restore the feeling of breast reconstruction.Intercostal nerve is mixed nerve.At present,foreign scholars have gradually reported intercostal nerve anastomosis as the recovery means feeling breast reconstruction.In this paper,through the observation of the clinical effect of abdominal nerve anastomosis of artery perforator flap in breast reconstruction surgery,To evaluate the efficacy and complications of the reconstruction of the breast,and to evaluate the subjective and objective sensory recovery,analysis of the clinical value of the operation in breast reconstruction in order to provide a reference for the selection of treatment options for breast reconstruction.ObjectiveThrough the retrospective analysis in our hospital adopt breast reconstruction operation in patients with clinical data,To accept the nerve anastomosis of abdominal wall artery perforator flap for breast reconstruction surgery and simple abdominal wall artery perforator flap for breast reconstruction surgery in the treatment of the patients were observed.To study the curative effect and safety of the two kinds of operation,and the subjective and objective sensory recovery of reconstructed breasts,And compare the difference.To further explore the clinical value of breast reconstruction with nerve anastomosis,The related research enriches and perfects the breast reconstruction.Methods52 patients with breast cancer who received Shanghai Ninth People’s Hospital,Kaifeng Central Hospital and the First Affiliated Hospital of Xinxiang Medical University from June 2013 to June 2015 were collected and all female patients.27-57 years old,average(35.8 + 4.7);52 patients are lack of unilateral breast,on the right side of27 cases,on the left side of the 25 cases;Operation method are autologous free transplantation under abdominal artery perforators flap breast reconstruction,10 cases are immediate breast reconstruction(stage I of breast reconstruction),42 cases is the second phase of breast reconstruction.The simple DIEP flap for breast reconstruction of 26 patients in the control group,The implementation of the neural anastomosis of abdominal wall artery perforator flap for breast reconstruction in 26 cases as experimental group.The patients in the control group were 28-53 years old,average age(36.4±4.2);And all the lesions were unilateral;The lesion: 12 cases on the left side,right side in 14 cases;4 cases for immediate breast reconstruction patients,preoperative both by biopsy pathology diagnosed with breast cancer,Clinical staging: 2 cases of stage I,2 cases of stage II A.Second phase of 22 cases of breast reconstruction;Cesarean delivery operation is always in5 cases,both for the longitudinal incision scar.The experimental group of patients aged29-57 years old,average age(37.1±4.6);The lesion: 13 cases on the left side,right side in13 cases;Six patients for immediate breast reconstruction,both by biopsy pathology diagnosed with breast cancer,preoperative clinical staging:2 cases of stage I,4 cases of stage II A;Phase ii breast reconstruction 20 cases;Cesarean delivery operation is always3 cases,all are longitudinal incision scar.Respectively on 2 groups of patients with surgery and evaluate the perioperative complications of breast reconstruction and feeling.The measurement and evaluation of the objective feeling including pressure sensation,touch,pain,Leng Jue,hot sensation,two-point discrimination and vibration perception.Test method: The subjects were placed in a quiet room,Occlusion eyes to reduce visual interference,Respectively on the contralateral and ipsilateral breast,inside,outside,outside the four quadrant and central detection.Record the standard for the patient to have no sense of the above objective feeling,And compared with the healthy side to determine whether the feeling is weakened or has reached the normal level.Score standard for no sense of 0 points,A slight feeling of1 points,And the healthy side is basically the same as the total is 2 points.Each test was repeated at least three times,In the three test results are the same given record,With the final score statistics.The subjective feeling is carried out in the form of questionnaire,Including the case of the reconstruction of the breast can have a sense of,Do you feel any breast reconstruction,Is there a difference between sex and surgery,Are you satisfied with the appearance of the reconstructed breasts,Reconstituted breasts to meet your expectations,The overall satisfaction of reconstituted breast,Whether it will again choose this surgery and whether it will recommend this surgery to patients around.All the experimental data were analyzed by SPSS19.0 statistical software,Measurement data are expressed in((?)±s),The differences among the measurement data sets were compared with the independent samples t test,Count data line X2 test,Specifiedα=0.05,In P<0.05,the difference was statistically significant..Results1.General results: 52 patients were successfully completed surgery,No deaths during hospitalization.Patients in the control group.The flap area is 9-14 cm × 31-45 cm,The median of 11.2×37.6cm.The recipient vessels were selected in the third intercostal space near the internal thoracic artery and vein.Operation time 5.5-13.5 hours,average(7.8±2.1)hours.Postoperative radiotherapy alone in 1 cases,1 patients received chemotherapy alone,Radiotherapy and chemotherapy were received in 5 cases.In the experimental group,the area of skin flap was 30-45 cm × 10-14 cm,and the median was 11.5 × 36.8cm.The recipient vessels were selected in the third intercostal space near the internal thoracic artery and vein.The operation time of 6-14 hours,the average(7.5±2.2)hours.1 cases received postoperative radiotherapy,2 cases were treated with chemotherapy,4 patients received radiotherapy and chemotherapy.2 groups of patients with operation time and the size of the flaps showed no significant difference(P>0.05).2.Comparison of surgical treatment: 2 groups of patients were followed up for effective.The follow-up time was 3-12 months,average(6.3±2.7)months.All patients survived,In the control group,the therapeutic effect was excellent in 6 cases,good in 14 cases and poor in 6 cases.In the experimental group,the efficacy was excellent in 12 cases,good in 13 cases and poor in 1 cases.By comparative analysis,the experimental group patients were significantly higher than the control group(P<0.05),The difference was statistically significant.3.Comparison of the complications: The control group of patients hospitalized for14-22 days,the average(17.4±2.1)days.5 cases of varying degrees of necrosis of distal flap during hospitalization after operation again recovered after cleaning;Fat liquefaction in 1 cases,given intermittent suture,strengthen the cure after treatment.The experimental group of patients hospitalized for 12-22 days,the average(16.7 ±2.2)days.4 cases of varying degrees of necrosis of distal flap during hospitalization after operation again recovered after cleaning;There were 1 cases of fat liquefaction,intermittent removal of suture,strengthen the healing after dressing.No abdominal wall hernia,abdominal wall hernia and incision infection were found in the 2 groups.By comparative analysis,there was no significant difference in the incidence of complications between the 2 groups(P>0.05).4.Objective sensory comparison: 2 groups of patients were followed up for effective.The follow-up time was 3-12 months,average(6.3±2.7)months.All patients survived.After first months,there was no significant difference between the 2 groups in the groups(P>0.05): pressure sensation,tactile sensation,pain sensation,Leng Jue,thermal sensation,two point discrimination and vibration perception,But 3thmonth after surgery,In the experimental group,the sensation score of the reconstructed breast was higher than that of the control group(P<0.05),The difference was statistically significant.At 6thmonths after operation,The difference is more obvious(P<0.05).5.Subjective sensation comparison: In the subjective sense of the survey,There was no significant difference in scores between the 2 groups(P>0.05)first months after operation.In the third and sixth months after surgery,there were significant differences between the control group and the control group(P<0.05),But in whether it will again choose this operation and whether it will recommend this surgery to patients around,There was no significant difference between the 2 groups(P>0.05).Conclusions1.Anastomosis nerve inferior epigastric artery perforator flap and pure inferior epigastric artery perforator flap in breast reconstruction has better curative effect.But the abdominal nerve anastomosis under the perforator artery flap has more advantages in postoperative breast appearance.2.Abdominal nerve anastomosis under perforating artery flap and the inferior epigastric perforator artery flap has good safety.3.Anastomosis artery perforator flap breast reconstruction for patients with abdominal wall after nerve can obtain good subjective and objective feeling.Sensory reconstruction should be as part of the breast reconstruction,more conducive to the recovery of postoperative quality of life. |
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