早期乳腺癌施行单纯乳房切除加前哨淋巴结活检术临床疗效对比研究

Clinical effect of simple mastectomy combined with sentinel lymph nodes biopsy in early breast cancer: a comparative study

目的研究早期乳腺癌在单纯乳房切除加前哨淋巴结冰冻活检阴性基础上,不再施行腋窝淋巴结清扫术,评估术后早期患侧上肢功能及远期生存状况,分析单纯前哨淋巴结活检术的安全性与可行性。方法对TNM分期在T1-2N0M0早期乳腺癌患者,施行单纯乳腺切除术,术中前哨淋巴结快速冰冻活检均为阴性转移者45例,随机分为两组,治疗组(23例)为仅前哨淋巴结活检,对照组(22例)为继续腋窝淋巴结(I-II水平)清扫术,两组术后均行同法放化疗,比较分析两组患者的患侧上肢功能状况及远期生存差异。结果比较术后1、2、4周患者患侧上臂周径:治疗组3次与术前差异无统计学意义(P>0.05);对照组1、2周时上臂周径明显长于术前(P<0.05),4周时差异无统计学意义(P>0.05)。肩关节功能Neer评分比较:治疗组术后1、2周得分与术前比较,差异有统计学意义(P<0.05),4周时得分与术前相当(P>0.05);对照组术后术前比较,差异均有统计学意义(P<0.05),且术后4周治疗组在Neer得分与肩关节外展角度评估上均优于对照组(P<0.05)。术后随访半年:治疗组无患侧上肢淋巴水肿,对照组出现上肢淋巴水肿5例,差异显著(P<0.05);治疗组的Neer得分与肩关节外展角度与术前比较,差异无统计学意义(P>0.05),但对照组均小于术前,差异有统计意义(P<0.05),且术后半年,治疗组的Neer得分与肩关节外展角度优于对照组;两组均未发生肿瘤复发、转移及腋窝淋巴结肿大。结论早期乳腺癌且前哨淋巴结快速冰冻活检阴性转移者,施行单纯乳房切除加前哨淋巴结活检术,在术后评估肩关节功能Neer评分、肩关节外展角度及患侧上肢淋巴水肿发生上,明显优于外加腋窝淋巴结清扫术,且远期的复发、转移、生存状况二者差异无统计学意义,其安全性、可行性得到验证,临床继续随访,可更加清晰的评估其安全性。

Objective： To evaluate the affected side upper limb function and long-term survival of early breast cancer patients trea- ted by simple mastectomy based on negative result of sentinel lymph nodes biopsy without axillary lymph node dissection, analyze the safety and feasibility of simple sentinel lymph nodes biopsy. Methods ： The early breast cancer patients of TNM stage T1-2N0M0 underwent sim- ple mastectomy, 45 patients were found with negative result of fast frozen biopsy of sentinel lymph nodes during operation, then they were randomly divided into two groups, 23 patients in treatment group received only sentinel lymph nodes biopsy, while 22 patients in control group received axillary lymph node dissection at the level of Ⅰ - Ⅱ ; after operation, the patients in the two groups were treated with chemora- diotherapy using the same method; the affected side upper limb function and long-term survival in the two groups were compared and ana- lyzed. Results： Comparison of affected side upper limb circumferences after one, two, and four weeks of treatment： there was no statistically significant difference between before and after treatment in treatment group （P〉0. 05） ; in control group, affected side upper limb circumfer- ences after one and two weeks were statistically significantly longer than those before treatment （ P〈0.05 ）, but there was no statistically sig- nificant difference between after four weeks of treatment and before treatment （P〉0. 05 ） . Comparison of Neer score of shoulder function： there were statistically significant differences in Neer scores of shoulder function between after one and two weeks of treatment and before treatment in treatment group （P〈0. 05 ）, there was no statistically significant difference in Neer score of shoulder function between after four weeks of treatment and before treatment （ P〉0. 05 ） ; in control group, there were statistically significant differences in Neer scores of shoul- der function between after one, two and four weeks of treatment and before treatment （ P〈0. 05 ）, Neer score of shoulder function and shoul- der abduction angle after four weeks of treatment in treatment group were statistically significantly better than those in control group （P〈0. 05 ） . Postoperative follow-up： no affected side upper limb edema occurred in treatment group, five patients with affected side upper limb edema were found in control group, there was statistically significant difference （P〈0. 05 ） ; in treatment group, there was no statistically sig- nificant difference in Neer score of shoulder function and shoulder abduction angle between after one, two, and four weeks of treatment and before treatment, but in control group, Neer score of shoulder function and shoulder abduction angle after one, two, and four weeks of treat- ment were statistically significantly less than those before treatment ; after six months of treatment, Neer score of shoulder function and shoul- der abduction angle in treatment group were better than those in control group; no tumor recurrence, metastasis, and axillary lymphadenecta- sis occurred in the two groups. Conclusion： For the early breast cancer patients with negative result of fast frozen biopsy during operation, simple mastectomy combined with sentinel lymph nodes biopsy were significantly superior to simple mastectomy combined with sentinel lymph nodes biopsy and axillary lymph node dissection in aspects of postoperative evaluation of Neer score of shoulder function, shoulder abduction angle, and occurrence of affected side Upper limb edema; there is no significant difference in long-term recurrence, metastasis, and survival between the two methods, the safety and feasibility are verified, further foUow-up can evaluate the safety more clearly.