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| 題 名 | Early Experience of the Use of Cohesive Silicone Implants for Breast Reconstruction=果凍矽膠義乳應用於乳房重建之早期經驗 |
|---|---|
| 作 者 | 李存昌; 傅如鵬; 張舜程; 陳天牧; 陳錫根; | 書刊名 | 臺灣整形外科醫學會雜誌 |
| 卷 期 | 20:2 2011.06[民100.06] |
| 頁 次 | 頁103-111 |
| 分類號 | 416.414 |
| 關鍵詞 | 果凍矽膠義乳; 乳房重建; Breast reconstruction; Silicone gel implant; Radiotherapy; Capsule contracture; |
| 語 文 | 英文(English) |
| 中文摘要 | 背景: 矽膠義乳於西元1960年代開始應用於隆乳及乳房重建手術。因懷疑矽膠義乳會造成自體免疫疾病及結締組織疾病,台灣於西元1992年宣佈禁止使用矽膠義乳植入人體。經過多次臨床試驗,矽膠義乳的安全性已被證實無虞。台灣衛生署於西元2008年11月開始針對乳房重建的病患准許矽膠義乳的使用。 目的: 此研究的的目的是檢驗在單一之醫學中心,果凍矽膠義乳使用於乳房重建手術的預後和臨床經驗。 材料和方法: 這是一個回溯性研究,針對西元2008年12月至2010年8月於三軍總醫院接受果凍矽膠義乳乳房重建之病患,進行預後的分析。針對病患的基本資料及手術方法收集記錄,且以併發症及二次手術的頻率作爲預後指標。利用自我評量表作爲病患術後滿意度的評估。 結果: 在本研究中共有28個果凍矽膠義乳使用在在21個乳房重建病患身上。併發症發生率爲10.7%(3/28)。最常見的併發症爲傷口感染(7.1%; 2/28)。未發現義乳破裂的情形。在立即性乳房重建和延遲 性乳房重建的併發症比率比較上沒有統計意義(1/13vs.2/15; p=1.00, Fisher's exact test)。共有兩位病患接受二次手術,分別是因爲放射性潰瘍及持續義乳不適症狀。自我評量問卷顯示在整體滿意度及自信心恢復上有良好的結果。在我們研究中沒有發現任何病患發生結締組織疾病。 結論: 針對果凍矽膠義乳應用於乳房重建,我們的早期研究說明果凍矽膠義乳提供一個具有美觀性、安全性及實用性的選擇且有相對低的手術併發症及二次手術發生率。 |
| 英文摘要 | Background: The silicone gel implants have been widely used for breast augmentation and reconstruction since 1960s. In 1992, the use of the silicone gel implants for breast reconstruction and augmentation was limited by United States Food and Drug Administration (FDA) because of a possible link to connective tissue diseases. Implant manufacturers began developing new generation silicone implants, so-called "cohesive gel" implants, that had increased silicone cross-linking to create a more viscous gel. Several prospective, multicenter trials had been performed to ensure their safety and efficacy. The cohesive silicone implant was qualified for the use of breast reconstruction in Taiwan on Nov, 2008. As the silicone gel controversy has resolved, the reintroduction of gel devices as the preferred implant following two-stage or one stage breast reconstruction surgery was suggested with improved aesthetics Aim and Objectives: The purpose of this study was to examine the surgical outcomes of a single medical center in a consecutive series of breast reconstruction cases using the cohesive silicone implants. Materials and methods: A retrospective chart review was conducted to identify all patients who underwent breast reconstruction with cohesive silicone breast implant in a single medical center over 21 months period (Dec 2008 to Aug 2010). For each patient, demographic information, comorbidities, and surgical information (implant size, number, the type of excision, incision site and concomitant surgery) were recorded. In addition, outcomes were analyzed to identify complications and the need for surgical revision. The cosmetic result was evaluated with the self-assessment sheets. Results: A total of 28 smooth wall cohesive silicone gel implants were placed in 21 patients during the 21-month study period. The overall complication rate per implant was 10.7% (3/28). The most common complication was wound infection (7.1%; 2/28). No implant rupture or gel bleed was found. No significant difference of complication rate was found between the patients who had immediate or delayed breast reconstruction (1/13 vs. 2/15; p=1.00, Fisher's exact test). Two revisions were noted in our case series due to radiation ulcer with implant extrusion and implant intolerance. The self-assessment report revealed a good result of the overall satisfaction and improvement in self-confidence (each of the average scores was 8.5 and 8.3 in a 10-point scale). Eighty-eight percent of the patients (16/18), who returned the self-assessment sheets, would recommend other patient to do the breast reconstruction with cohesive silicone implants. No any connective tissue disease was found in our study. Conclusions: In our study, no causal relationship has been established between cohesive silicone breast implants and other disease. Our study illustrates a good preliminary result of the cosmetics, safety and efficacy of smooth wall cohesive silicone implants use for breast reconstruction in both immediate and delayed breast reconstruction groups with relative low complication and revision rate. This is the first preliminary result of breast reconstruction with cohesive silicone implants in Taiwan and long-term follow-up should be continued. |
本系統中英文摘要資訊取自各篇刊載內容。