PAHG取出同期和二期乳房再造的效果及术后评价

摘要 目的：对聚丙烯酰胺水凝胶注射物（polyacrylamide hydrogel，PAHG）取出同期和二期乳房再造术的疗效及预后情况进行比较，为临床治疗提供一定的经验。方法：以2017年4月~2019年4月我院收治的PAHG取出乳房再造患者为研究对象，采用随机法结合患者需求分为I组和II组，I组进行PAHG取出同期乳房再造，II组进行PAHG取出后二期乳房再造，以手术指标（手术时间、出血量、拔管时间和住院时间）、并发症（疼痛、感染、肿胀和形态不佳等）、术后生命质量及自尊评分为指标对两组疗效及预后情况进行评价。结果：I组和II组第一阶段手术时间、出血量、拔管时间和住院时间比较，均无显著差异(P＞0.05)，II组第二阶段各项指标较第一阶段均显著降低(P＜0.05)；两组患者各项并发症发生率均无显著差异（P＞0.05），但I组患者疼痛和形态不佳发生率略高于II组，II组包膜挛缩发生率略高于I组，两组并发症总发生率无统计学差异（P＞0.05）；I组术后1个月生命质量和自尊评分均显著高于II组（P<0.05），两组术后6个月和12个月两组生命质量和自尊评分无明显差异（P＞0.05）；与术后1个月相比，两组患者术后6个月和12个月的生命质量和自尊评分均显著提高（P<0.05）。结论：两种PAHG取出后乳房再造术的效果和预后均良好，可根据患者情况和自身意愿进行选择，值得临床推广应用。

The Effect and Postoperative Evaluation of Breast Reconstruction in the Same Period and Second Stage after PAHG Removal

ABSTRACT Objective: Compare the efficacy and prognosis of PAHG removal during the same period and second stage breast reconstruction to provide some experience for clinical treatment. Methods: Taking the PAHG patients undergoing breast reconstruction in our hospital from April 2017 to April 2019 as the research object, they were divided into group I and group II using random methods combined with the needs of patients. Group I received breast reconstruction during the same period after taking PAHG, and Group II received second-stage breast reconstruction after taking PAHG. The operation indexes (operation time, bleeding volume, extubation time and hospitalization time), complications (pain, infection, swelling and poor morphology, etc.), postoperative quality of life and self-esteem score were used as indicators to evaluate the efficacy and prognosis of the two groups. Results: There was no significant difference in the first stage operation time, bleeding volume, extubation time and hospital stay between group I and group II(P>0.05). The indexes in the second phase of Group II were significantly lower than those in the first phase(P<0.05). There was no significant difference in the incidence of various complications between the two groups of patients (P>0.05). However, the incidence of pain and poor morphology in group I was slightly higher than that in group II, and the incidence of capsular contracture in group II was slightly higher than that in group I. The total incidence of complications between the two groups was not statistically different(P>0.05); The quality of life and self-esteem scores of group I at 1 month after operation were significantly higher than those of group II(P<0.05). There were no significant differences in the quality of life and self-esteem scores at 6 and 12 months after operation between the two groups(P>0.05). Compared with 1 month after operation, the quality of life and self-esteem scores of the two groups of patients at 6 and 12 months after operation were significantly improved (P<0.05). Conclusion: The results and prognosis of breast reconstruction after PAHG removal are good, and they can be selected according to the patient''s condition and their own wishes, which is worthy of clinical promotion and application.