术中热低渗液浸泡化疗预防乳癌术后局部复发的研究

Prevention of local recurrence of the breast cancer with intrao perative hot hypotonic solution soaking chemotherapy

目的 探讨乳癌术中手术创面热低渗液浸泡化疗在预防乳癌术后复发中的作用。方法 将 85例行乳癌手术患者随机分为实验组 (n =43)和对照组 (n =42 ) ,两组均于术毕用生理盐水冲洗手术创面并取冲洗液送检癌细胞。然后实验组行手术创面热低渗液浸泡化疗 ,对照组行手术创面生理盐水浸泡 ,两组均取浸泡液送检癌细胞。对手术创面癌液细胞液检出率及乳癌术后 2年局部复发率分别进行对比研究。结果 浸泡前生理盐水冲洗液癌细胞检出率实验组为 30 2 3 % ,对照组为 2 6 19% (P >0 .0 5 ) ;浸泡后浸泡液中癌细胞检出率实验组 2 33 % ,对照组为 19 0 5 % ,差异显著 (P <0 .0 5 )。 2年后局部复发率实验组液为 4 6 5 % ,对照组为 2 1 43 % ,差异显著 (P <0 .0 5 )。结论 乳癌术中手术创面一次性热低渗液浸泡化疗具有杀灭术野表面癌细胞的作用 ,可降低乳癌术后的局部复发率 ,提高患者的生存质量 ,是一种较理想的辅助治疗方法。

Objective To study the prevention effects of intraoperative hot hypotonic solution soaking chemotherapy (HHSSCT) on cancer recurrence after resection of breast cancer (BC). Methods 85 cases of BC treated by operation were randomly divided into study group(n=43) and control group (n=42). Before the operative wound closing, the wound of both groups were washed with normal saline solutions first and the washing solutions were collected for examination of residual cancer cell (RCC), then the operative wounds of study group were treated with HHSSCT, while the wounds of control group were soaked with normal saline solutions (NS) only. The soaking solutions of both groups were collected for examination of RCC. The rates of RCC in operative wounds and the postoperative locally recurrence rates of BC in the two groups were compared. Results The rates of RCC after the first NS soaking in study group and of control group were 30.23% and 26.19% respectively (P>0.05). The rate of RCC after HHSSCT was 4.7% in study group; after second NS soaking, the rate of RCC was 19.1% in control group. The difference between the two groups was statistically significant (P<0.05). The localy recurrent rates were 4.7% in sutdy group and 21.4% in control group twoyears after operation(P<0.05). Conclusions HHSSCT used once in the wound of operation of BC could kill the cancer cells residualed in the operative wounds, and reduce the local recurrentce rate of BC after radical operation. So it is an ideal adjuvant therapy of BC.