性，乳房，乳腺癌，手术方式

　　越来越多早期乳腺癌患者正在选择乳房切除术，但是既往缺乏针对乳房感性（乳房对两性亲密的作用）的研究。

　　2017年10日，美国乳腺外科医师学会、外科肿瘤学会《外科肿瘤学年鉴》将正式发表罗德岛妇幼医院、布朗大学、德克萨斯大学MD安德森癌症中心、纽约圣彼得医院、巴尔的摩医学中心、麻省总医院、哈佛医学院的研究报告，探讨了肿块切除术、乳房切除术、乳房切除重建术后女性的乳房感性，并分析了手术方式对性功能的影响。

　　该研究使用调查问卷和女性性功能指数对2000～2013年接受乳腺癌手术的女性进行调查，通过病历回顾收集人口统计学和手术数据，使用克鲁斯卡沃利斯秩和检验分析女性性功能指数评分，使用卡方或费希尔精确检验分析归类数据。

　　结果，共有453人受邀入组，268人（59%）完成调查问卷。其中，肿块切除术、乳房切除重建术、乳房切除术分别占69.4%、22.4%、8.2%。

　　无论手术方式如何，乳房、胸壁对两性亲密的重要性均显著减弱（肿块切除术、乳房切除术、乳房切除重建术前后：83→74%、95→47%、93→77%，P=0.0006、0.003、0.002）。

　　性功能无显著差异（肿块切除术、乳房切除重建术、乳房切除术后的女性性功能指数评分中位分别为28.2、27.5、25.9，P=1.0）。

　　肿块切除术与乳房切除重建术相比，女性性功能指数评分较高，使外观满意度较高（29.0比22.6，P=0.002）、乳房爱抚仍然令人愉悦（28.8比26.5，P=0.04）、乳房仍可使两性亲密（28.8比24.8，P=0.1）。

　　因此，乳腺癌手术与乳房感性降低有相关性。然而，肿块切除术的乳房感性和外观满意度评分较佳，并且似乎与术后性功能较佳有相关性。这些数据可以指导手术咨询，并影响生存结局。

　　对此，梅奥医院佛罗里达分院的外科和肿瘤科专家发表述评：乳腺癌术后的性功能与乳房感性仍然重要。

相关阅读

Ann Surg Oncol. 2017 Sep 13. [Epub ahead of print]

Sexual Function and Breast-Specific Sensuality Remain Important After Breast Cancer Surgery.

Sarah A. McLaughlin, Lauren F. Cornell, Dawn M. Mussallem.

Mayo Clinic Florida, Jacksonville, USA.

DOI: 10.1245/s10434-017-6086-x

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Ann Surg Oncol. 2017 Oct;24(11):3133-3140.

Breast-Specific Sensuality and Sexual Function in Cancer Survivorship: Does Surgical Modality Matter?

Gass JS, Onstad M, Pesek S, Rojas K, Fogarty S, Stuckey A, Raker C, Dizon DS.

Women and Infants' Hospital of Rhode Island, Providence, RI, USA; Brown University Warren Alpert Medical School, Providence, RI, USA; MD Anderson Cancer Center, Houston, TX, USA; St. Peter's Hospital, St. Peter's Health Partners Medical Associates, Albany, NY, USA; Greater Baltimore Medical Center, Towson, MD, USA; Women and Infants Hospital, Providence, RI, USA; Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Medicine, Boston, MA, USA.

PURPOSE: More early-staged breast cancer patients are choosing mastectomy. No studies have addressed breast-specific sensuality (BSS), defined as the breast's role during intimacy. We explored BSS among women undergoing lumpectomy (L), mastectomy alone (M), or with reconstruction (MR) and analyzed the association of surgical modality with sexual function.

METHODS: Women undergoing breast cancer surgery between 2000 and 2013 were eligible for survey using investigator-generated questions and the Female Sexual Function Index (FSFI). Demographic and surgical data were collected by chart review. The Kruskal-Wallis test was used to analyze FSFI scores, and χ 2 or Fisher's exact tests were used for categorical data.

RESULTS: Of 453 invited participants, 268 (59%) completed the survey. Of these, 69.4, 22.4, and 8.2% underwent L, MR, or M, respectively. The importance of the breast/chest wall during intimacy declined significantly regardless of surgical modality (L 83-74%, p = 0.0006; M 95-47%, p = 0.003; MR 93-77%, p = 0.002). No difference in sexual function was found between L, MR, and M (median FSFI score 28.2, 27.5, 25.9, respectively; p = 1.0). Comparing L versus MR, higher FSFI scores resulted with appearance satisfaction (29.0 vs. 22.6 p = 0.002) and preserved BSS as pleasurable breast caress (28.8 vs. 26.5, p = 0.04) and the breast as part of intimacy (28.8 vs. 24.8, p = 0.1).

CONCLUSIONS: Breast cancer surgery is associated with lowered BSS. However, BSS and appearance satisfaction scores are better for L and appear to correlate with improved sexual function postoperatively. These data may guide surgical counseling and contribute to survivorship outcomes.

PMID: 28608119

DOI: 10.1245/s10434-017-5905-4