Quality of Life, Patients’ Satisfaction, and Aesthetic Outcome after Pedicled or Free TRAM Flap Breast Surgery
Quality of Life, Patients’ Satisfaction, and Aesthetic Outcome after Pedicled or Free TRAM Flap Breast Surgery
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带蒂或游离 TRAM 皮瓣乳房手术后的生活质量、患者满意度和美学效果
DOI：
10.1097/00006534-200104150-00007
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发表时间：
2001
影响因子：
3.6
通讯作者：
M. Wickman
中科院分区：
文献类型：
--
作者：
Å. Edsander‐Nord;Y. Brandberg;M. Wickman
乳腺癌手术后进行乳房重建主要是为了改善患者的生活质量。本研究旨在调查带蒂或游离横腹直肌肌皮瓣（TRAM）术后患者对乳房再造的满意度和生活质量，并从客观和主观角度评价乳房再造的美观效果。 63 名患者（36 名带蒂皮瓣和 27 名游离 TRAM 皮瓣）回答了两份问卷；在该组中，53 例（27 例带蒂皮瓣和 26 例游离 TRAM 皮瓣）参加了美学评估。问卷由两部分组成：一个是研究特定部分，涉及对乳房重建结果的满意度，另一个是标准化的健康相关生活质量部分，即简表 36 问卷。美学检查包括客观部分，其中测量重建乳房和对侧乳房的各种距离。使用热塑性铸造系统测量乳房的体积。使用压平眼压计评估乳房的柔软度。由三名整形外科医生组成的小组查看了每位患者的四张标准化照片，并主观评估了美学结果。专家组从 10 个分量表上评估了乳房重建。手术组之间患者对重建的满意度没有统计学上的显着差异。在患者对美容结果的自我评估中，游离 TRAM 皮瓣组的对称程度评估较高。健康相关生活质量简表 36 问卷显示带蒂皮瓣组和游离皮瓣组之间没有差异。与参考人群相比，乳房再造组感到更疲倦和“疲惫”，更不平静，更不快乐，更不安。与带蒂 TRAM 皮瓣组相比，游离皮瓣组在客观评估中达到了更高的对称度，并且从三人小组中获得的分数普遍更高。患者和专家组对美容效果的评价之间存在很强的相关性；一般来说，专家组对乳房美容效果的评价与患者的满意度相关。 （塑料重建外科 107：1142，2001 年。）
Breast reconstructions after breast cancer surgery are primarily performed to improve patients’ quality of life. This study was performed to investigate patients’ satisfaction with breast reconstruction and quality of life after pedicled or free transverse rectus abdominis musculocutaneous (TRAM) flap surgery and to evaluate the aesthetic result of the breast reconstruction both objectively and subjectively. Sixty‐three patients (36 with pedicled flaps and 27 with free TRAM flaps) answered two questionnaires; of this group, 53 (27 with pedicled flaps and 26 with free TRAM flaps) participated in an aesthetic evaluation. The questionnaires consisted of two parts: one study‐specific part concerning satisfaction with the result of the breast reconstruction, the other a standardized health‐related quality of life part, the Short Form‐36 questionnaire. The aesthetic examination consisted of an objective part in which various distances on the reconstructed and contralateral breast were measured. The volumes of the breasts were measured using a thermoplastic cast system. The softness of the breasts was assessed using applanation tonometry. A panel consisting of three plastic surgeons looked at four standardized photographs of each patient and evaluated the aesthetic outcome subjectively. The panel evaluated the breast reconstruction on 10 subscales. No statistically significant difference between the surgical groups was seen regarding the patients’ satisfaction with the reconstruction. In the patients’ self‐assessment of the cosmetic outcome, the degree of symmetry was assessed higher in the free TRAM flap group. The healthrelated quality of life Short Form‐36 questionnaire revealed no difference between the pedicled and free flap groups. Compared with a reference population, the breast‐reconstructed group felt more tired and “worn out,” less peaceful, more unhappy, and more restless. The free flap group reached a higher degree of symmetry in the objective evaluation and received generally higher scores from the three‐member panel, compared with the pedicled TRAM flap group. A strong correlation between the patients’ and the panel's evaluations of the cosmetic outcome was seen; generally, the panel's evaluation of the cosmetic result of the breast correlated with the satisfaction of the patients. (Plast. Reconstr. Surg. 107: 1142, 2001.)