乳房重建术后乳腺癌患者性生活及情感体验的质性研究

doi:10.3969/j.issn.1674-8115.2021.12.008

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (12): 1597-1601.doi: 10.3969/j.issn.1674-8115.2021.12.008

• 临床护理专题 • 上一篇

乳房重建术后乳腺癌患者性生活及情感体验的质性研究

甘露¹^,²(), 金玉翡¹, 任清¹, 董晓晶¹, 张男¹()

^1.上海交通大学医学院附属瑞金医院护理部，上海 200025
^2.上海交通大学护理学院，上海 200025

收稿日期:2021-05-13 出版日期:2021-10-29 发布日期:2021-10-29
通讯作者: 张男 E-mail:gl21899@rjh.com.cn;zn21076@rjh.com.cn
作者简介:甘露（1991—），女，主管护师，硕士生；电子信箱：gl21899@rjh.com.cn。
基金资助:
上海市教育委员会护理高原学科项目(Hlgy1844qnhb);上海交通大学医学院科技基金(jyhz1908);上海交通大学医学院附属瑞金医院护理科研基金(RJHK-2019-2)

Experience of sexuality after breast reconstruction in breast cancer survivors: a qualitative study

Lu GAN¹^,²(), Yu-fei JIN¹, Qing REN¹, Xiao-jing DONG¹, Nan ZHANG¹()

^1.Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
^2.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China

Received:2021-05-13 Online:2021-10-29 Published:2021-10-29
Contact: Nan ZHANG E-mail:gl21899@rjh.com.cn;zn21076@rjh.com.cn
Supported by:
Shanghai Municipal Education Commission Gaoyuan Nursing Grant Support(Hlgyl844qnhb);Science and Technology Fund of Shanghai Jiao Tong University School of Medicine(jyhz1908);Nursing Research Fund of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine(RJHK-2019-2)

摘要/Abstract

摘要：

目的·了解接受乳房重建术后的乳腺癌患者对于性的认知与态度、性生活状态的改变体验和应对方式。方法·通过目的性抽样，以在上海交通大学医学院附属瑞金医院内接受乳房重建术的乳腺癌患者为研究对象。采用一般资料问卷对于患者的基本信息进行收集。采用现象学研究方法就患者接受乳房重建术后性生活状态的改变体验和应对方式进行半结构式的深入访谈，并根据Colaizzi七步分析法进行资料分析。结果·共纳入12名受访者，中位年龄40（28~51）岁，均接受了腹壁下动脉穿支皮瓣转移术，术后病程中位数为17.5个月。受访者的性生活及情感体验可归纳为3个主题。①受访者对乳房重建术后性生活改变的感知：受访者均对性的重要性有充分的认识；大部分受访者在完成乳腺癌辅助治疗后可恢复性生活；乳房重建术导致的体象改变和皮肤感觉受损影响了患者的性体验。②受访者对乳房重建术后性生活改变的应对：受访者与配偶之间关于性的交流较少；受访者主动启动补偿机制，减轻不良性体验。③受访者术后对恢复性生活的支持需求：受访者对于性健康的需求较高，但医患间关于性问题的沟通较少；受访者期望通过合适的途径得到专业的信息支持。结论·乳房重建术后患者对于性生活和情感体验相对积极，但缺乏与配偶及医护人员关于性问题的沟通。医护人员在临床工作中应针对患者性问题进行有效沟通和评估并及时给予干预，以提高其生活质量。

关键词: 乳房重建术, 乳腺癌, 性体验, 质性研究

Abstract:

Objective·To study the recognization and attitudes regarding sex of the breast cancer patients who underwent breast reconstruction, and their experience of altered sexual status and their coping styles.

Methods·The breast cancer patients who underwent breast reconstruction surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, were selected as the study population through purposive sampling. The general information questionnaire was used to collect the basic information of the patients. A semi-structured in-depth interview on the experience of sexual status change and coping style after breast reconstruction surgery was conducted by using phenomenological research method. The data were analyzed according to seven steps of Colaizzi′s method.

Results·A total of 12 respondents with a median age of 40 (28?51) years were included, all of whom underwent deep inferior epigastric perforator flap with an median postoperative duration of 17.5 months. Their sexual life and emotional experience could be summarized into 3 themes. ① The patients′ perceptions of changes in sexual life after breast reconstruction surgery: all the respondents had a good understanding of the importance of sex; most of the respondents could resume sexual life after completing adjuvant treatment for breast cancer; the altered body image and the impaired skin sensation resulting from breast reconstruction surgery affected the patients′ sexual experience. ② The patients′ response to the changes in sexual life after breast reconstruction: there was less communication about sex between the patients and their spouses; the patients actively initiated compensatory mechanisms to mitigate adverse sexual experience. ③ The patients′ need for support in resuming sexual life after surgery: the patients had a high demand for sexual health, but there was little communication between the doctors and the patients on sexual issues; the patients expected to receive professional information support through appropriate access.

Conclusion·After breast reconstruction, the patients are relatively positive about sexual life and emotional experience, but lack of communication with their spouses and medical staff about sexual problems. Health care providers should effectively communicate, assess the patients′ sexual problems, and provide timely interventions in clinical work to improve their quality of life.

Key words: breast reconstruction, breast cancer, sexual experience, qualitative study

中图分类号:

R473.6

甘露, 金玉翡, 任清, 董晓晶, 张男. 乳房重建术后乳腺癌患者性生活及情感体验的质性研究[J]. 上海交通大学学报(医学版), 2021, 41(12): 1597-1601.

Lu GAN, Yu-fei JIN, Qing REN, Xiao-jing DONG, Nan ZHANG. Experience of sexuality after breast reconstruction in breast cancer survivors: a qualitative study[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(12): 1597-1601.

图/表 1

参考文献 23

1	IARC. Latest global cancer data: cancer burden rises to19.3 million new cases and 10.0 million cancer deaths in 2020[R/OL]. [2021-03-27]. .
2	Kedde H, van de Wiel HB, Weijmar Schultz WC, et al. Sexual dysfunction in young women with breast cancer[J]. Support Care Cancer, 2013, 21(1): 271-280.
3	Panjari M, Bell RJ, Davis SR, et al. Sexual function after breast cancer[J]. J Sex Med, 2011, 8(1): 294-302.
4	张淑荣, 侯继凤, 赵新华. 乳腺癌术后形体改变导致性功能心理障碍的调查分析[J]. 承德医学院学报, 2004, 21(2): 181-182.
5	Platt J, Baxter NN, McLaughlin J, et al. Does breast reconstruction after mastectomy for breast cancer affect overall survival? Long-term follow-up of a retrospective population-based cohort[J]. Plast Reconstr Surg, 2015, 135(3): 468e-476e.
6	van Mierlo DR, Lopez Penha TR, Schipper RJ, et al. No increase of local recurrence rate in breast cancer patients treated with skin-sparing mastectomy followed by immediate breast reconstruction[J]. Breast, 2013, 22(6): 1166-1170.
7	Berbers J, van Baardwijk A, Houben R, et al. 'Reconstruction: before or after postmastectomy radiotherapy?' A systematic review of the literature[J]. Eur J Cancer, 2014, 50(16): 2752-2762.
8	Eltahir Y, LLCH Werners, Dreise MM, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: comparison of patient-reported BREAST-Q and other health-related quality-of-life measures[J]. Plast Reconstr Surg, 2013, 132(2): 201e-209e.
9	Ng SK, Hare RM, Kuang RJ, et al. Breast reconstruction post mastectomy: patient satisfaction and decision making[J]. Ann Plast Surg, 2016, 76(6): 640-644.
10	Albornoz CR, Bach PB, Mehrara BJ, et al. A paradigm shift in US Breast reconstruction: increasing implant rates[J]. Plast Reconstr Surg, 2013, 131(1): 15-23.
11	Chen JJ, Huang NS, Xue JY, et al. Current status of breast reconstruction in Southern China: a 15 year, single institutional experience of 20 551 breast cancer patients[J]. Medicine (Baltimore), 2015, 94(34): e1399.
12	Gilbert E, Ussher JM, Perz J. Sexuality after breast cancer: a review[J]. Maturitas, 2010, 66(4): 397-407.
13	Colaizzi PF. Psychological research as the phenomenologists views it[M]//Valle RS, King M. Existential-phenomenological alternatives for psychology. New York: Oxford University Press, 1978: 48.
14	Leunissen T, de Boer M, van der Hulst R, et al. Exploring novel dimensions of body experience after breast reconstruction[J]. JPRAS Open, 2016, 7: 32-41.
15	Matthews H, Turner A, Williamson I, et al. 'It′s a silver lining': a template analysis of satisfaction and quality of life following post-mastectomy breast reconstruction[J]. Br J Health Psychol, 2018, 23(2): 455-475.
16	邓燕萍, 刘雅清, 吴美华. 女性乳腺癌患者配偶心理体验的质性研究[J]. 护理实践与研究, 2014(12): 94-95.
17	Kinsinger SW, Laurenceau JP, Carver CS, et al. Perceived partner support and psychosexual adjustment to breast cancer[J]. Psychol Health, 2011, 26(12): 1571-1588.
18	Rottmann N, Gilså Hansen D, dePont Christensen R, et al. Satisfaction with sex life in sexually active heterosexual couples dealing with breast cancer: a nationwide longitudinal study[J]. Acta Oncol, 2017, 56(2): 212-219.
19	高冰红. 认知干预联合家庭支持改善育龄期乳腺癌患者术后性生活质量的应用价值[J]. 社区医学杂志, 2018, 16(10): 69-71.
20	Hordern AJ, Street AF. Communicating about patient sexuality and intimacy after cancer: mismatched expectations and unmet needs[J]. Med J Aust, 2007, 186(5): 224-227.
21	张骋姣, 潘令仪, 包家林, 等. 上海市年轻女性乳腺癌患者性功能障碍的横断面调查研究[J]. 中国性科学, 2018, 27(10): 141-147.
22	Carter J, Laechetti C, Andersen BL, et a1. Interventions to address sexual problems in people with cancer:American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario guideline[J].J Clin Oncol, 2018, 36(5): 492-511.
23	Watson M, Kissane DW. 唐丽丽, 译. 癌症患者心理治疗手册[M]. 北京: 北京大学医学出版社, 2016: 207-218.

No.	Age/year	Surgical approach	Course after operation/month	Treatment stage	Adjuvant therapy	Education	Marriage	Fertility status	Employment	Q1	Q2	Q3
A	51	DIEP	16	Completed	C+T	College	Yes	None	Yes	Yes	Yes	No
B	37	DIEP	17	Completed	T+R	College	Yes	1	Yes	Yes	Yes	No
C	44	DIEP	23	Completed	E	College	Yes	1	Yes	Yes	No	No
D	50	DIEP	19	Completed	C+T	Master	Divorced	1	Yes	Yes	No	No
E	40	DIEP	17	Completed	‒	Master	Yes	2	Yes	Yes	Yes	No
F	30	DIEP	16	E	C+E	College	Yes	1	No	Yes	No	No
G	49	DIEP	20	E	E	College	Yes	1	No	Yes	Yes	No
H	32	DIEP	16	E	E	College	Yes	None	Yes	Yes	Yes	No
I	40	DIEP	20	E	C+T+E	College	Yes	1	Yes	Yes	No	No
J	31	DIEP	18	Completed	C+T	College	Yes	1	Yes	Yes	Yes	No
K	28	DIEP	21	E	E	Master	Yes	1	Yes	Yes	Yes	No
L	42	DIEP	14	Completed	C+T	High school	Yes	1	No	Yes	No	No

No.	Age/year	Surgical approach	Course after operation/month	Treatment stage	Adjuvant therapy	Education	Marriage	Fertility status	Employment	Q1	Q2	Q3
A	51	DIEP	16	Completed	C+T	College	Yes	None	Yes	Yes	Yes	No
B	37	DIEP	17	Completed	T+R	College	Yes	1	Yes	Yes	Yes	No
C	44	DIEP	23	Completed	E	College	Yes	1	Yes	Yes	No	No
D	50	DIEP	19	Completed	C+T	Master	Divorced	1	Yes	Yes	No	No
E	40	DIEP	17	Completed	‒	Master	Yes	2	Yes	Yes	Yes	No
F	30	DIEP	16	E	C+E	College	Yes	1	No	Yes	No	No
G	49	DIEP	20	E	E	College	Yes	1	No	Yes	Yes	No
H	32	DIEP	16	E	E	College	Yes	None	Yes	Yes	Yes	No
I	40	DIEP	20	E	C+T+E	College	Yes	1	Yes	Yes	No	No
J	31	DIEP	18	Completed	C+T	College	Yes	1	Yes	Yes	Yes	No
K	28	DIEP	21	E	E	Master	Yes	1	Yes	Yes	Yes	No
L	42	DIEP	14	Completed	C+T	High school	Yes	1	No	Yes	No	No

[1]	周天浩, 辛肇晨, 杜少倩, 曹源, 许静轩, 劳曾红, 王红霞. 乳腺癌类器官共培养技术的建立和优化[J]. 上海交通大学学报(医学版), 2021, 41(8): 1017-1024.
[2]	季艳杰, 罗浩, 蔡海燕, 刘欣宇, 金诗佳, 粟深月, 徐含章, 雷虎, 吴英理. CDDO-Me对三阴性乳腺癌细胞泛素特异性蛋白酶2a活性及细胞增殖的抑制作用[J]. 上海交通大学学报(医学版), 2021, 41(8): 1025-1032.
[3]	王成志, 邓华云, 庞智, 黄雷. MUC1在HER2阳性乳腺癌发病中的作用及机制研究[J]. 上海交通大学学报(医学版), 2021, 41(7): 839-848.
[4]	张海燕, 储晓英. 非阿片类镇痛药应用在全身麻醉喉罩置入的乳腺癌保乳手术中的可行性[J]. 上海交通大学学报(医学版), 2021, 41(5): 637-641.
[5]	张佳玲, 张凤春, 徐迎春. 乳腺癌脑转移系统治疗的研究进展[J]. 上海交通大学学报(医学版), 2021, 41(5): 671-677.
[6]	郝艳云, 俞思慧, 陆静, 顾湘, 张帆, 程金科, 王田实. SIRT3去SUMO化修饰调节乳腺癌细胞MCF7增殖及化疗药物敏感性的研究[J]. 上海交通大学学报(医学版), 2021, 41(12): 1557-1563.
[7]	赵晓军, 乔志刚, 梁挺宇, 安艳玲. 乳腺癌易感基因1蛋白在脑胶质瘤中的表达及对替莫唑胺敏感性的影响[J]. 上海交通大学学报(医学版), 2021, 41(1): 118-122.
[8]	陈思，刘春良，赵倩，孙海鹏，刘云霞. 基于生存分析的生物信息学方法筛选乳腺癌枢纽基因和关键通路[J]. 上海交通大学学报（医学版）, 2020, 40(3): 294-.
[9]	叶欣，周晓云，杨莉，王杰，何奇. 不同年龄范围界定下的年轻乳腺癌患者的临床病理特征及预后分析[J]. 上海交通大学学报（医学版）, 2020, 40(3): 351-.
[10]	程龙1，徐五琴2，张鹏1，黄建军1，李小宁1. 下调miR-27a表达对三阴乳腺癌细胞增殖、迁移和侵袭的影响[J]. 上海交通大学学报（医学版）, 2020, 40(2): 188-.
[11]	张凤春1, 2，张硕渊3，陈天恩3，徐迎春3. PD-1/PD-L1通路在三阴性乳腺癌预后预测及治疗中的意义[J]. 上海交通大学学报（医学版）, 2020, 40(1): 128-.
[12]	何沁，张伟滨，沈宇辉. 乳腺癌脊柱转移患者预后预测模型的构建[J]. 上海交通大学学报(医学版), 2020, 40(09): 1243-1248.
[13]	陆裕杰，金泽宇，李亚芬，沈坤炜，陈伟国，陈小松. 乳腺癌局部区域复发病灶受体状态检测及对后续治疗的指导价值[J]. 上海交通大学学报（医学版）, 2019, 39(9): 1071-.
[14]	孙晓寅，莊志刚，傅韵，成小林. 乳腺癌 X线征象及其术后病理特征分析[J]. 上海交通大学学报（医学版）, 2019, 39(4): 398-.
[15]	董晓晶 1，张男 1，甘露 1，吴怡颖 1，陈允允 1，方琼 2. 个案管理模式下老年乳腺癌患者辅助治疗依从性分析[J]. 上海交通大学学报（医学版）, 2019, 39(2): 170-.

乳房重建术后乳腺癌患者性生活及情感体验的质性研究

Experience of sexuality after breast reconstruction in breast cancer survivors: a qualitative study

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 1

参考文献 23

相关文章 15

编辑推荐

Metrics