前哨淋巴结活检联合乳房区段切除术治疗早期乳腺癌患者的围手术期护理观察

Sentinel lymph node biopsy combined with mastectomy for the perioperative nursing observation of early breast cancer patients

目的探讨前哨淋巴结活检联合乳房区段切除手术即保乳保腋术相比传统乳腺癌改良根治术对早期乳腺癌患者的手术创伤的区别及优势。方法选取蚌埠医学院第一附属医院2012年8月—2013年8月收治的120例乳腺癌患者,按随机数字表法分为对照组和观察组,每组各60例。对照组患者为接受传统乳腺癌改良根治术治疗的患者,观察组患者为接受前哨淋巴结活检并在术中冰冻提示阴性而免除腋窝淋巴结活检的前提下联合乳房区段切除术(保乳保腋术)治疗的患者。术后2组患者根据术后病理、淋巴结转移情况(仅观察组)及免疫组化的结果均接受对应的化疗、内分泌治疗或放疗等辅助治疗,其中观察组患者术后必行辅助放疗。分别比较2组患者的手术时间,术中出血量、术后并发症的发生情况以及术后的康复时间,同时比较2组患者术后的3年存活率、复发率及转移率。结果观察组患者的手术时间、术中出血量、术后住院时间、术后并发症的发生率、术后康复时间均低于对照组,差异有统计学意义(均P<0.01),同时2组患者术后3年存活率、复发率及转移率比较差异无统计学意义(均P>0.05)。结论前哨淋巴结活检联合乳房区段切除术相比传统改良根治术而言可有效减少患者的手术时间、术中出血量,同时减少术后不良反应发生,提高生活质量,未降低患者术后存活率,且没有增加复发、转移率。

Objective To investigate the difference and advantages of breast conservation surgery and segmental mastectomy [also known as breast-conserving surgery（ BCS） ] and traditional modified mastectomy for early stage breast cancer. Methods One hundred and twenty breast cancer patients admitted in our hospital from 2012 to 2013 were randomly divided into control group and observation group,with 60 cases in each group. The patients in the control group were treated with traditional modified mastectomy. The patients in the observation group were treated with BCS and exclusion of axillary lymph node biopsy,which were performed sentinel lymph nodes（ SLN） biopsy with intraoperative frozen section（ FS） and proved negative on FS. The patients in the postoperative group were treated with adjuvant chemotherapy,endocrine therapy or radiotherapy according to the postoperative pathology,lymph node metastasis（ observation group only）and immunohistochemistry. And the patients in the observation group were also treated with adjuvant radiotherapy. The operation time,intraoperative blood loss,postoperative complications and postoperative rehabilitation,as well as the survival rate,recurrence rate and metastasis rate of 3-year were compared between the two groups. Results The operation time,intraoperative blood loss,postoperative hospitalization time,postoperative complication rate and postoperative rehabilitation time were significantly lower in the observation group than those in the control group（ P 〈0. 01）. There was no significant difference in survival rate,recurrence rate and metastasis rate of 3-year between the two groups（ P〉0. 05）.Conclusion Compared with traditional modified mastectomy,breast conservation surgery and segmental mastectomy can effectively reduce the operation time,intraoperative blood loss,at the same,it does not decrease the postoperative survival rate and not increase the recurrence and transfer rate. It is a great therapy and worthy of clinical promotion.