بازسازي پستان بعد از ماستكتومي: تجمل يا ضرورت؟

Breast Reconstruction after Mastectomy, Necessity or Luxury?

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺍﻣـﺮﻭﺯﻩ ﺍﮐﺜﺮ ﺯﻧﺎﻧﻲ ﮐﻪ ﺑﻪ ﺩﻧﺒﺎﻝ ﺳﺮﻃﺎﻥ ﭘﺴﺘـﺎﻥ ﺗﺤﺖ ﻣﺎﺳﺘﮑﺘـﻮﻣﻲ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﻧﺪ، ﺍﻗـﺪﺍﻡ ﺑﻪ ﺟـﺮﺍﺣﻲ ﺑﺎﺯﺳﺎﺯﻱ ﭘﺴﺘﺎﻥ ﻣﻲ ﮐﻨﻨﺪ. ﺩﺭ ﺑﺴﻴﺎﺭﻱ ﺍﺯ ﻣـﻮﺍﺭﺩ ﭘﺮﻭﺗﺰ ﻳﺎ ﻓﻼﭖ ﻋﻀﻠﻪ ﻻﺗﻴﺴﻤـﻮﺱ ﺩﻭﺭﺳﻲ ﺟﻬﺖ ﺍﻳﻨﻜﺎﺭ ﻣـﻮﺭﺩ ﺍﺳﺘﻔﺎﺩﻩ ﻗـﺮﺍﺭ ﻣﻲ ﮔﻴـﺮﺩ. ﺑﻪ ﺩﻧﺒﺎﻝ ﺗﺤـﻮﻻﺕ ﺍﺧﻴـﺮ ﺩﺭ ﺯﻣﻴﻨﻪ ﺑﺎﺯﺳﺎﺯﻱ ﭘﺴﺘـﺎﻥ، ﻓﻼﭖ ﻋﺮﺿﻲ ﻋﻀﻠﻪ ﺭﮐﺘﻮﺱ ﺷﮑﻤـﻲ TRAM)( ﺑﻪ ﻃﻮﺭ ﻭﺳﻴﻊ ﺗﻮﺳﻂ ﺟﺮﺍﺣﺎﻥ ﭘﻼﺳﺘﻴﮏ ﺑﻪ ﮐﺎﺭ ﮔﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺳﺖ. ﻫـﺪﻑ ﺍﺯ ﺍﻧﺠﺎﻡ ﺍﻳﻦ ﻃﺮﺡ، ﺑﺮﺭﺳﻲ ﺍﻧﻮﺍﻉ ﻭ ﺷﻴـﻮﻉ ﺟﺮﺍﺣﻲ ﻫﺎﻱ ﺑﺎﺯﺳﺎﺯﻱ ﭘﺴﺘـﺎﻥ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺗﻮﺳﻂ ﻣﺆﻟﻔﻴﻦ ﻭ ﺩﺭ ﮐﻨﺎﺭ ﺁﻥ ﺑﺮﺭﺳﻲ ﻣـﺰﺍﻳﺎ ﻭ ﻣﻌﺎﻳﺐ ﻫﺮ ﻧﻮﻉ ﻋﻤﻞ ﺑﻮﺩﻩ ﺍﺳﺖ ﻭ ﺩﺭ ﻧﻬﺎﻳﺖ ﻣﻴـﺰﺍﻥ ﺭﺿﺎﻳﺘﻤﻨﺪﻱ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ ﻧﻮﻉ ﻋﻤﻞ ﺍﻧﺠـﺎﻡ ﺷﺪﻩ ﻣﻮﺭﺩ ﺳﻨﺠﺶ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺩﺭ ﻳﮏ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻄﻌﻲ ـ ﺗﻮﺻﻴﻔﻲ ﻃﻲ 14 ﺳﺎﻝ، 148 ﻣـﻮﺭﺩ ﺍﺯ ﺟﺮﺍﺣﻲ ﻫﺎﻱ ﺑﺎﺯﺳﺎﺯﻱ ﭘﺴﺘﺎﻥ ﺍﻧﺠـﺎﻡ ﺷﺪﻩ ﺗﻮﺳﻂ ﻣﺆﻟﻔﻴﻦ ﻣـﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﺍﻃﻼﻋﺎﺕ ﺩﻣـﻮﮔﺮﺍﻓﻴﮏ ﺁﻧﻬﺎ ﺍﺯ ﭘﺮﻭﻧﺪﻩ ﻫﺎﻱ ﭘﺰﺷﮑﻲ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺳﺘﺨـﺮﺍﺝ ﮔﺮﺩﻳﺪﻩ ﻭ ﺩﺭ ﺣـﺪﻭﺩ 88 ﺩﺭﺻﺪ ﺍﺯ ﺑﻴﻤـﺎﺭﺍﻥ ﺗﺤﺖ ﭘﻴﮕﻴـﺮﻱ ﺩﺭﻣﺎﻧﻲ ﺑﻪ ﻣـﺪﺕ 5 ﺳﺎﻝ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﻧﺘﺎﻳﺞ ﺑﺮﺭﺳﻲ ﻫﺎﻱ ﻓﻮﻕ ﺗﻮﺳﻂ ﺑﺮﻧﺎﻣﻪ SPSSﻣﻮﺭﺩ ﺗﺠـﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﻄـﺎﻟﻌـﺎﺕ ﺭﻭﻱ 148 ﺑﻴﻤـﺎﺭ ﻧﺸـﺎﻥ ﺩﺍﺩ ﮐـﻪ ﺷـﺎﻳﻊ ﺗـﺮﻳﻦ ﻋﻤـﻞ ﺟـﺮﺍﺣـﻲ ﺷــﺪﻩ ﺑـﺮﺍﻱ ﺑﺎﺯﺳـﺎﺯﻱ ﭘﺴﺘـﺎﻥ، ﻋﻤـﻞ ﺟـﺮﺍﺣﻲ ﺑـﺎ ﺑﺎﺯﺳـﺎﺯﻱ ﻓﻼﭖ TRAM، 127 ﻣـﻮﺭﺩ )86/3٪( ﺑـﻮﺩﻩ ﺍﺳـﺖ ﻛـﻪ ﺑﻌـﺪ ﺍﺯ ﺁﻥ ﺑﺎﺯﺳـﺎﺯﻱ ﭘﺴﺘـﺎﻥ ﺑﺎ ﺍﺳﺘﻔـﺎﺩﻩ ﺍﺯ ﺗﻴﺸـﻮﺍﮐﺴﭙـﺎﻧـﺪﺭ ﻭ ﺳﭙـﺲ ﭘـﺮﻭﺗﺰ ﭘﺴﺘـﺎﻥ ﻗـﺮﺍﺭ ﺩﺍﺷﺘـﻪ ﺍﺳـﺖ. ﺷﺎﻳﻌﺘـﺮﻳﻦ ﻋـﻮﺍﺭﺽ ﻣﺸﺎﻫـﺪﻩ ﺷــﺪﻩ ﺑـﻪ ﺗﺮﺗﻴــﺐ، ﻧﮑــﺮﻭﺯ ﺑﺎﻓــﺖ ﭼـﺮﺑﻲ 13ﻣـﻮﺭﺩ )8/7٪( ﻭ ﺳــﺮﻭﻣـﺎ 12 ﻣـﻮﺭﺩ )8/1٪( ﺑـﻮﺩﻩ ﺍﺳـﺖ. ﺍﻳـﻦ ﻋـﻮﺍﺭﺽ ﺍﮐﺜـﺮﺍﹰ ﺩﺭ ﺟـﺮﺍﺣﻲ ﻓﻼﭖ TRAM ﺩﻳــﺪﻩ ﺷــﺪﻩ ﺍﺳﺖ. ﺭﺿﺎﻳﺘﻤﻨﺪﻱ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ ﺟﺮﺍﺣﻲ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺭﻭﻱ ﭘﺴﺘﺎﻥ ﻭ ﺷﮑـﻢ ﺩﺭ ﻧﻮﻉ TRAM ﺩﺭ ﺣﺪ ﻋﺎﻟﻲ ﺑﺪﻳﻦ ﺗﺮﺗﻴﺐ ﺑﻮﺩﻩ ﺍﺳﺖ: 25٪ ﺑﺮﺍﻱ ﺟﺮﺍﺣﻲ ﺭﻭﻱ ﭘﺴﺘﺎﻥ ﻭ 31٪ﺑﺮﺍﻱ ﺟﺮﺍﺣﻲ ﺭﻭﻱ ﺷﮑﻢ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻧﺘﺎﻳﺞ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎﻥ ﺩﺍﺩ ﮐﻪ ﻓﻼﭖTRAM ﺑﺮﺍﻱ ﺑﺎﺯﺳﺎﺯﻱ ﭘﺴﺘـﺎﻥ ﻳﮏ ﺭﻭﺵ ﺍﻳﻤـﻦ ﻭ ﻗﺎﺑﻞ ﺍﻋﺘﻤﺎﺩ ﺍﺳﺖ ﮐﻪ ﻧﺘﺎﻳﺞ ﺯﻳﺒﺎﻳﻲ ﻗﺎﺑﻞ ﺗﻮجهي ﻫﻤﺮﺍﻩ ﺑﺎ ﺭﺿﺎﻳﺘﻤﻨﺪﻱ ﺑﺎﻻﻱ ﺑﻴﻤﺎﺭﺍﻥ ﺭﺍ ﺩﺭﺑﺮﺩﺍﺭﺩ.

Introduction & Objective: These days, the majority of women who are undergoing mastectomy can also have breast reconstruction. Implants and latissimus dorsi flaps are some kinds of surgery that can be performed. The development of Transverse Rectus Abdominis Myocutaneous (TRAM) flap, enabled surgeons to use it, extensively for breast reconstruction. The main aim of this study was determination of the prevalence of different reconstructive surgery in Iran, find out advantages and disadvantage of these procedure and also evaluation of satisfaction of the patients. Materials & Methods: In a descriptive and cross-sectional study 148 patients, undergoing breast reconstructive surgery during 14 years, were evaluated. Their demographic data, age, kind of surgery gathered from their medical files. Then they followed for 5 years and complication of surgery and their satisfaction were evaluated. Data analyzed with SPSS software. Results: The most kind of surgery was TRAM flap 127 (86.3%) then was tissue expanders, implants, respectively; Fat necrosis 13 (8.7%) patients, seroma in 12 (8.1%) patients were the most complication of TRAM flap surgery. Satisfaction of patients were excellent in 31%, 25% respectively for breast and abdomen reconstructive surgery. Conclusions: This study suggests that the TRAM flap for breast reconstruction is a safe and reliable technique which provides an excellent cosmetic outcome with a high degree of patients satisfaction.