張欣 1,2 , 張蒲容 2 , 陳潔 1 , 鄭潔 2 , 呂青 1
  • 1.四川大學華西醫(yī)院甲狀腺乳腺外科（成都 610041）;;
  • 2.四川省腫瘤醫(yī)院乳腺科（成都 610041）;

目的 通過調(diào)查女性乳腺疾病患者對于保乳和乳房重建手術(shù)的認同度，初步探討國內(nèi)保乳率和乳房重建率低下的原因，以指導乳腺外科醫(yī)生更有針對性地進行溝通和選擇治療方式。方法 通過自制問卷對華西醫(yī)院乳腺外科收治的139例乳腺癌患者和224例非乳腺癌患者的年齡、職業(yè)、學歷、對于保乳手術(shù)及乳房重建手術(shù)的態(tài)度以及重建方式的選擇進行調(diào)查。 結(jié)果 乳腺癌組回收有效問卷117份，非乳腺癌組回收199份。乳腺癌組選擇保乳率為23.9%（28/117），選擇乳房重建率為35.9%（42/117）。 非乳腺癌組選擇保乳率為53.3%（106/199），選擇乳房重建率為63.8%（127/199）。 在2組中，選擇保乳率和乳房重建率均隨患者年齡增大而下降（乳腺癌組P值分別為0.002和0.000，非乳腺癌組P值分別為0.000和0.000），隨學歷增高而升高或有升高趨勢（乳腺癌組P值分別為0.029和0.296，非乳腺癌組P值分別為0.081和0.019）。 乳腺癌和非乳腺癌患者中系個體經(jīng)營者的選擇保乳率及乳房重建率均相對較高（P=0.013，P=0.042； P=0.032，P=0.044）。 患者的年齡、職業(yè)和學歷與乳房重建方式的選擇無關(guān)（P gt;0.05）。 結(jié)論 年紀較輕、文化程度較高、工作條件較好的乳腺疾病患者保乳及乳房重建的愿望較強烈，應(yīng)注重加強與該類患者之間進行關(guān)于保乳及乳房重建相關(guān)知識的溝通，有針對性地選擇適合患者條件的治療方式。

引用本文： 張欣,張蒲容,陳潔,鄭潔,呂青. 關(guān)于女性乳腺疾病患者對保乳及乳房重建認同度的調(diào)查. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(12): 1240-1244. doi: 復制

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2. Caffo O, Amichetti M, Ferro A, et al. Pain and quality of life after surgery for breast cancer [J]. Breast Cancer Res Treat, 2003； 80(1): 39-48.
3. Bergen PI, Heerdt AS, Moore MP, et al. Breast conservation therapy for invasive carcinoma of the breast [J]. Curr Prold Surg, 1995; 32（3）: 191-248.
4. 林本耀. 乳腺癌保乳治療學 [M]. 北京: 清華大學出版社, 2004: 113-116.
5. 張保寧. 早期乳腺癌保乳手術(shù)的相關(guān)問題 [J]. 中國腫瘤, 2007； 16（10）： 758-760.
6. Lam WW, Fielding R, Ho EY. Predicting psychological morbidity in Chinese women after surgery for breast carcinoma [J]. Cancer, 2005； 103(3): 637-646.
7. Engel J, Kerr J, Schlesinger-Raab A, et al. Quality of life following breast-conserving therapy or mastectomy: results of 5-year prospective study [J]. Breast J, 2004； 10(3): 223-231.
8. 孫強， 陳凜， 陳杰， 等. 乳腺癌術(shù)后乳房缺損患者的心理調(diào)查 [J]. 中華整形外科雜志， 2003； 19(4)： 294-296.
9. Ganz PA, Kwan L, Stanton AL, et al. Quality of life at the end of primary treatment of breast cancer: first results from the moving beyond cancer randomized trial [J]. J Natl Cancer Ins, 2004； 96(5): 376-387.
10. 張疆莉, 祁富生, 白清林. 乳腺癌患者社會心理特征的研究 [J]. 中國神經(jīng)精神疾病雜志, 2002； 28(5): 330-332.
11. Tomatis L. Between the body and mind: the involvement of psychological factors in the development of multifactorial diseases [J]. Eur J Cancer, 2001； 37(Suppl 8): S148-S152.
12. Shapiro SL, Lopez AM, Schqartz GE, et al. Quality of life and breast cancer: relationship to psychosocial variables [J]. J Clin Psychol, 2001； 57(4): 501-519.
13. Northous LL, Caffey M, Deichelbohrer L, et al. The quality of life of African American women with breast cancer [J]. Res Nurs Health, 1999, 22(6): 449-460.
14. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer [J]. N Engl J Med, 1995； 333（22）: 1456-1461.
15. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastetomy, lumpectomy, and lumpectomy plus irradiction for the treatment of breast cancer [J]. N Engl J Med, 2002； 347(16): 1233-1241.
16. Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer -an overview of the randomized trials [J]. N Engl J Med, 1995； 333（22）: 1444-1456.
17. 張保寧. 乳腺癌保乳手術(shù)的研究進展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2005； 12(3): 204-206.
18. Nour A. Breast-conserving therapy in low-literacy patients in a developing country [J], Breast J， 2003； 9(2): 71-73.
19. 沈鎮(zhèn)宙， 邵志敏. 現(xiàn)代乳腺腫瘤學進展 [M]. 上海： 上?？茖W技術(shù)文獻出版社， 2002： 117-119.
20. Dusková M, Kanková H, Tvrdek M, et al. Breast reconstruction as an integral part of a breast carcinoma therapy (a self-present final report of a reseach project IGA MZ CR) [J]. Acta Chir Plast, 2001； 43(2): 42-53.
21. Jensen JA. Should improved mastectomy and reconstruction alter the primary management of breast cancer? [J]. Plast Reconstr Surg, 1999； 103(4): 1308-1310.
22. Slavin SA, Schnitt SJ, Duda RB, et al. Skin-sparing mastectomy and immediate reconsruction: Oncologic risks and aesthetic results in patients with early-stage breast cancer [J]. Plast Reconstr Surg, 1998; 102(1): 49-62.
23. Birdsell DC, Jenkins H, Berkel H. Breast cancer diagnosis and survival in women with or without breast implants [J]. Plast Reconstr Surg, 1993； 92(5): 795-800.
24. Pusic A， Thompson TA， Kerrigan CL， et al. Surgical options options the early-stage breast cancer: factors with patient choice and postopretivequality of life [J]. Plast Reconstr Surg， 1999； 104(5): 1325-1333.
25. 栩軼， 師蘭香. 原發(fā)性乳腺癌患者對改良根治術(shù)后乳腺重建認同程度的調(diào)查研究 [J]. 解放軍護理雜志， 2003； 20(3): 30-31.
  1. 1. Veronesi U, Salvadori B, Luini A, et al. Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomised trials on 1 973 patients [J]. Eur J Cancer, 1995； 31A(10): 1567-1569.
  2. 2. Caffo O, Amichetti M, Ferro A, et al. Pain and quality of life after surgery for breast cancer [J]. Breast Cancer Res Treat, 2003； 80(1): 39-48.
  3. 3. Bergen PI, Heerdt AS, Moore MP, et al. Breast conservation therapy for invasive carcinoma of the breast [J]. Curr Prold Surg, 1995; 32（3）: 191-248.
  4. 4. 林本耀. 乳腺癌保乳治療學 [M]. 北京: 清華大學出版社, 2004: 113-116.
  5. 5. 張保寧. 早期乳腺癌保乳手術(shù)的相關(guān)問題 [J]. 中國腫瘤, 2007； 16（10）： 758-760.
  6. 6. Lam WW, Fielding R, Ho EY. Predicting psychological morbidity in Chinese women after surgery for breast carcinoma [J]. Cancer, 2005； 103(3): 637-646.
  7. 7. Engel J, Kerr J, Schlesinger-Raab A, et al. Quality of life following breast-conserving therapy or mastectomy: results of 5-year prospective study [J]. Breast J, 2004； 10(3): 223-231.
  8. 8. 孫強， 陳凜， 陳杰， 等. 乳腺癌術(shù)后乳房缺損患者的心理調(diào)查 [J]. 中華整形外科雜志， 2003； 19(4)： 294-296.
  9. 9. Ganz PA, Kwan L, Stanton AL, et al. Quality of life at the end of primary treatment of breast cancer: first results from the moving beyond cancer randomized trial [J]. J Natl Cancer Ins, 2004； 96(5): 376-387.
  10. 10. 張疆莉, 祁富生, 白清林. 乳腺癌患者社會心理特征的研究 [J]. 中國神經(jīng)精神疾病雜志, 2002； 28(5): 330-332.
  11. 11. Tomatis L. Between the body and mind: the involvement of psychological factors in the development of multifactorial diseases [J]. Eur J Cancer, 2001； 37(Suppl 8): S148-S152.
  12. 12. Shapiro SL, Lopez AM, Schqartz GE, et al. Quality of life and breast cancer: relationship to psychosocial variables [J]. J Clin Psychol, 2001； 57(4): 501-519.
  13. 13. Northous LL, Caffey M, Deichelbohrer L, et al. The quality of life of African American women with breast cancer [J]. Res Nurs Health, 1999, 22(6): 449-460.
  14. 14. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer [J]. N Engl J Med, 1995； 333（22）: 1456-1461.
  15. 15. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastetomy, lumpectomy, and lumpectomy plus irradiction for the treatment of breast cancer [J]. N Engl J Med, 2002； 347(16): 1233-1241.
  16. 16. Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer -an overview of the randomized trials [J]. N Engl J Med, 1995； 333（22）: 1444-1456.
  17. 17. 張保寧. 乳腺癌保乳手術(shù)的研究進展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2005； 12(3): 204-206.
  18. 18. Nour A. Breast-conserving therapy in low-literacy patients in a developing country [J], Breast J， 2003； 9(2): 71-73.
  19. 19. 沈鎮(zhèn)宙， 邵志敏. 現(xiàn)代乳腺腫瘤學進展 [M]. 上海： 上?？茖W技術(shù)文獻出版社， 2002： 117-119.
  20. 20. Dusková M, Kanková H, Tvrdek M, et al. Breast reconstruction as an integral part of a breast carcinoma therapy (a self-present final report of a reseach project IGA MZ CR) [J]. Acta Chir Plast, 2001； 43(2): 42-53.
  21. 21. Jensen JA. Should improved mastectomy and reconstruction alter the primary management of breast cancer? [J]. Plast Reconstr Surg, 1999； 103(4): 1308-1310.
  22. 22. Slavin SA, Schnitt SJ, Duda RB, et al. Skin-sparing mastectomy and immediate reconsruction: Oncologic risks and aesthetic results in patients with early-stage breast cancer [J]. Plast Reconstr Surg, 1998; 102(1): 49-62.
  23. 23. Birdsell DC, Jenkins H, Berkel H. Breast cancer diagnosis and survival in women with or without breast implants [J]. Plast Reconstr Surg, 1993； 92(5): 795-800.
  24. 24. Pusic A， Thompson TA， Kerrigan CL， et al. Surgical options options the early-stage breast cancer: factors with patient choice and postopretivequality of life [J]. Plast Reconstr Surg， 1999； 104(5): 1325-1333.
  25. 25. 栩軼， 師蘭香. 原發(fā)性乳腺癌患者對改良根治術(shù)后乳腺重建認同程度的調(diào)查研究 [J]. 解放軍護理雜志， 2003； 20(3): 30-31.