中华乳腺病杂志（电子版）
中華乳腺病雜誌（電子版）
중화유선병잡지（전자판）
Chinese Journal of Breast Disease (Electronic Version)
2015年
4期
257-263
,共7页
张燕娜%孙强%周易冬%茅枫%关竞红
張燕娜%孫彊%週易鼕%茅楓%關競紅
장연나%손강%주역동%모풍%관경홍
乳腺肿瘤%乳房切除术%保留乳房手术%知识宣教
乳腺腫瘤%乳房切除術%保留乳房手術%知識宣教
유선종류%유방절제술%보류유방수술%지식선교
Breast neoplasms%Mastectomy%Breast conserving surgery%Cancer education
目的：探讨术前乳腺癌保留乳房相关知识宣教对可保留乳房乳腺癌患者手术方式选择的影响。方法对2011年5月至11月北京协和医院乳腺外科收治的282例乳腺癌患者进行保留乳房相关知识宣教并进行问卷调查。比较保留乳房知识宣教前后保留乳房选择比例的变化,分析保留乳房组与全乳切除组手术方式选择的影响因素。患者年龄比较采用t检验,例数比较采用χ2检验或Mann-Whitney U检验,多因素分析采用 Logistic 回归分析。结果知识宣教后,保留乳房选择率由25.2%(71/282)降至19.1%(54/282)(χ2=12.430,P=0.002)。单因素分析显示：与全乳切除组相比,保留乳房组的平均年龄更低[(51.3±9.9)岁比(42.9±8.2)岁,t=6.216,P=0.000],受教育水平更高(大学及以上学历的比例：44.9%比75.0%,χ2=17.925,P=0.000),有职业患者的比例更高(66.3%比85.9%,χ2=9.372,P=0.009)。家属对手术方式的选择(P=0.001)以及患者在选择手术方式时是否受到家属影响(χ2=7.334,P=0.026)在保留乳房组与全乳切除组间的差异有统计学意义。多因素分析显示患者年龄(OR=0.907,95%CI：0.871~0.944, P=0.000)和患者家属对手术方式的选择(OR=2.028,95%CI：1.270~3.237, P=0.003)是患者保留乳房手术选择的独立影响因素。患者拒绝保留乳房手术的主要原因是对局部复发的担心(73.5%,150/204)；保留乳房失败后患者拒绝乳房再造的主要原因是对再造手术创伤的担心(53.8%,21/39)；选择全乳切除患者拒绝再造的两大原因分别为自身对形体改变的良好接受度(47.5%,95/200)以及年龄因素(46.5%,93/200)。结论手术方式的决策过程是医师、患者及家属共同参与的过程,医师有必要为可保留乳房乳腺癌患者及其家属提供详尽的手术相关信息,协助患者做出选择。
目的：探討術前乳腺癌保留乳房相關知識宣教對可保留乳房乳腺癌患者手術方式選擇的影響。方法對2011年5月至11月北京協和醫院乳腺外科收治的282例乳腺癌患者進行保留乳房相關知識宣教併進行問捲調查。比較保留乳房知識宣教前後保留乳房選擇比例的變化,分析保留乳房組與全乳切除組手術方式選擇的影響因素。患者年齡比較採用t檢驗,例數比較採用χ2檢驗或Mann-Whitney U檢驗,多因素分析採用 Logistic 迴歸分析。結果知識宣教後,保留乳房選擇率由25.2%(71/282)降至19.1%(54/282)(χ2=12.430,P=0.002)。單因素分析顯示：與全乳切除組相比,保留乳房組的平均年齡更低[(51.3±9.9)歲比(42.9±8.2)歲,t=6.216,P=0.000],受教育水平更高(大學及以上學歷的比例：44.9%比75.0%,χ2=17.925,P=0.000),有職業患者的比例更高(66.3%比85.9%,χ2=9.372,P=0.009)。傢屬對手術方式的選擇(P=0.001)以及患者在選擇手術方式時是否受到傢屬影響(χ2=7.334,P=0.026)在保留乳房組與全乳切除組間的差異有統計學意義。多因素分析顯示患者年齡(OR=0.907,95%CI：0.871~0.944, P=0.000)和患者傢屬對手術方式的選擇(OR=2.028,95%CI：1.270~3.237, P=0.003)是患者保留乳房手術選擇的獨立影響因素。患者拒絕保留乳房手術的主要原因是對跼部複髮的擔心(73.5%,150/204)；保留乳房失敗後患者拒絕乳房再造的主要原因是對再造手術創傷的擔心(53.8%,21/39)；選擇全乳切除患者拒絕再造的兩大原因分彆為自身對形體改變的良好接受度(47.5%,95/200)以及年齡因素(46.5%,93/200)。結論手術方式的決策過程是醫師、患者及傢屬共同參與的過程,醫師有必要為可保留乳房乳腺癌患者及其傢屬提供詳儘的手術相關信息,協助患者做齣選擇。
목적：탐토술전유선암보류유방상관지식선교대가보류유방유선암환자수술방식선택적영향。방법대2011년5월지11월북경협화의원유선외과수치적282례유선암환자진행보류유방상관지식선교병진행문권조사。비교보류유방지식선교전후보류유방선택비례적변화,분석보류유방조여전유절제조수술방식선택적영향인소。환자년령비교채용t검험,례수비교채용χ2검험혹Mann-Whitney U검험,다인소분석채용 Logistic 회귀분석。결과지식선교후,보류유방선택솔유25.2%(71/282)강지19.1%(54/282)(χ2=12.430,P=0.002)。단인소분석현시：여전유절제조상비,보류유방조적평균년령경저[(51.3±9.9)세비(42.9±8.2)세,t=6.216,P=0.000],수교육수평경고(대학급이상학력적비례：44.9%비75.0%,χ2=17.925,P=0.000),유직업환자적비례경고(66.3%비85.9%,χ2=9.372,P=0.009)。가속대수술방식적선택(P=0.001)이급환자재선택수술방식시시부수도가속영향(χ2=7.334,P=0.026)재보류유방조여전유절제조간적차이유통계학의의。다인소분석현시환자년령(OR=0.907,95%CI：0.871~0.944, P=0.000)화환자가속대수술방식적선택(OR=2.028,95%CI：1.270~3.237, P=0.003)시환자보류유방수술선택적독립영향인소。환자거절보류유방수술적주요원인시대국부복발적담심(73.5%,150/204)；보류유방실패후환자거절유방재조적주요원인시대재조수술창상적담심(53.8%,21/39)；선택전유절제환자거절재조적량대원인분별위자신대형체개변적량호접수도(47.5%,95/200)이급년령인소(46.5%,93/200)。결론수술방식적결책과정시의사、환자급가속공동삼여적과정,의사유필요위가보류유방유선암환자급기가속제공상진적수술상관신식,협조환자주출선택。
Objective To investigate the influence of cancer education on the breast-conserving surgery decision-making of breast cancer patients. Methods The cancer education concerning to breast-conserving surgery was given to 282 breast cancer patients treated in Department of Breast Surgery, Peking Union Medical College Hospital from May 2011 to November 2011, and then a questionnaire was conducted. All data of the participants were analyzed to compare the proportion of the patients choosing breast-conserving surgery before and after cancer education and detect the factors influencing the surgical choice in breast-conserving group and breast resection group. The patients’ ages were compared using t test. The numeration of cases were evaluated using χ2 test and Mann-Whitney U test. Logistic regression was also used for multivariate analysis. Results After cancer education, the proportion of the patients choosing breast-conserving surgery was decreased from 25. 2% to 19. 1% (χ2=12. 430, P=0. 002). Univariate analysis showed that compared with breast resection group, breast-conserving group had a younger age [ ( 42. 88 ± 8. 14 ) years vs ( 51. 31 ± 9. 90 ) years, t=6. 216, P=0. 000], higher education level (the proportion of the patients with college degree or above:75. 0% vs 44. 9%,χ2=17. 925,P=0. 000) and a higher rate of employment (85. 9% vs 66. 3%,χ2=9. 372,P=0. 009). There were significant differences in surgical choice of their family members (P<0. 001) and its influence on patients’ decision-making (P=0. 026) between these two groups. The multivariate analysis showed that the patients’ age (OR=0. 907, 95%CI: 0. 871 ~0. 944, P=0. 000) and the family members’ influence on patients’ decision-making ( OR = 2. 028, 95%CI:1. 270 ~ 3. 237, P = 0. 003 ) were two independent factors influencing the patient’s decision-making for breast-conserving surgery. Totally 150 patients refused BCS due to the fear of local recurrence ( 73. 5%, 150/204 ) . Twenty-one patients refused breast reconstruction if breast-conserving surgery were not successful because of the trauma of reconstruction surgery (53. 8%,21/39). The main reasons for breast resection patients to reject breast reconstruction lied to the acceptance of body image (47. 5%,95/200) and patients’ age (46. 5%,93/200). Conclusions The surgical decision-making process requires the participation of the doctors, patients and their family members. It is necessary for the physicians to provide detailed information to breast cancer patients with the breast-conserving probability and their family members and help them to make optimal decisions.
