CAJ | 학술논문

目的比较应用腹壁下动脉穿支(DIEP)皮瓣和带蒂横行腹直肌(TRAM)皮瓣行乳房重建术的术后并发症发生率和成本.方法回顾性分析2000年1月至2014年12月河北联合大学附属医院和唐山市人民医院行DIEP皮瓣和TRAM皮瓣乳房重建患者的临床资料.11例应用TRAM皮瓣进行了即刻乳房重建,19例应用了DIEP皮瓣.比较两组的治疗费用、住院时间和术后2年的并发症.结果主要并发症方面,脂肪液化在TRAM组有5例,DIEP组有1例,两组发生率差异有统计学意义(P=0.016),皮瓣坏死在TRAM组有1例,DIEP组无该并发症发生,两组均无腹壁疝气发生,两组差异均无统计学意义(P均＞0.05).次要并发症方面,术后血肿在TRAM组有4例,DIEP组1例,两组差异有统计学意义(P=0.047),伤口裂开在TRAM组有2例,DIEP组有1例,感染仅在TRAM组有1例,差异均无统计学意义(P均＞0.05).TRAM组平均治疗费用为(14 133.12±1 546.88)元,DIEP组为(16838.94±3 006.05)元,差异有统计学意义(P=0.010).TRAM组平均住院时间为(17.28±2.08)d,DIEP组为(18.39±2.87)d,两组差异无统计学意义(P＞0.05).结论近年来发展的DIEP皮瓣乳房重建技术临床结局更好,但经济负担更高.
목적 비교응용복벽하동맥천지(DIEP)피판화대체횡행복직기(TRAM)피판행유방중건술적술후병발증발생솔화성본.방법 회고성분석2000년1월지2014년12월하북연합대학부속의원화당산시인민의원행DIEP피판화TRAM피판유방중건환자적림상자료.11례응용TRAM피판진행료즉각유방중건,19례응용료DIEP피판.비교량조적치료비용、주원시간화술후2년적병발증.결과 주요병발증방면,지방액화재TRAM조유5례,DIEP조유1례,량조발생솔차이유통계학의의(P=0.016),피판배사재TRAM조유1례,DIEP조무해병발증발생,량조균무복벽산기발생,량조차이균무통계학의의(P균＞0.05).차요병발증방면,술후혈종재TRAM조유4례,DIEP조1례,량조차이유통계학의의(P=0.047),상구렬개재TRAM조유2례,DIEP조유1례,감염부재TRAM조유1례,차이균무통계학의의(P균＞0.05).TRAM조평균치료비용위(14 133.12±1 546.88)원,DIEP조위(16838.94±3 006.05)원,차이유통계학의의(P=0.010).TRAM조평균주원시간위(17.28±2.08)d,DIEP조위(18.39±2.87)d,량조차이무통계학의의(P＞0.05).결론 근년래발전적DIEP피판유방중건기술림상결국경호,단경제부담경고.
Objective To compare the complication and cost-effectiveness of the deep inferior epigastric perforator(DIEP) flap and transverse rectus abdominis myocutaneous(TRAM) flap.Methods From January 2000 to December 2014,all patients who underwent DIEP flap and TRAM flap in the People's Hospital of Tangshan and the Affiliated Hospital of North China University of Science and Technology, were selected.Eleven patients underwent immediate breast reconstruction with TRAM flaps and 19 patients with DIEP flaps.The treatment cost,length of hospitalization, and complication in the two year after surgery for each group were compared.Results For the major complications,there were 5 cases appeared fat necrosis in TRAM group, and 1 case in DIEP group,the differences was statistically significant(P=0.016).One case appeared flap loss in TRAM group,and DIEP group was zero,both of the two group had no abdominal wall hernia, there was no significant difference (P ＞ 0.05).For the minor complications, there were 4 cases appeared postoperative hematoma in TRAM group, and 1 case in DIEP group, the difference was statistically significant(P =0.047).Two cases appeared wound dehiscence in TRAM group,and DIEP group was 1 case, 1 case happened infection in TRAM group,there was no statistically significant difference(P＞0.05).The treatment costs were (14 133.12±1 546.88)yuan for the TRAM group and (16 838.94± 3 006.05)yuan the DIEP group, the difference was statistically significant (P =0.010).The hospital stay was (17.28± 2.08)days for the pedicled TRAM group and (18.39±2.87) days for the DIEP group,the different was not statistically significant(P＞0.05).Conclusion The DIEP flap has a better clinical outcomes,but more expensive.