保乳联合前哨淋巴结活检手术与改良根治术在早期乳腺癌治疗中的应用价值

Significance of breast-conserving surgery combined with sentinel lymph node biopsy and modified radical mastectomy in the treatment of early stage breast cancer

目的探讨保乳联合前哨淋巴结活检手术与改良根治术治疗早期乳腺癌对患者术后恢复及生活质量的影响。方法选取2015年7月至2018年7月间河南省内乡县人民医院收治的158例早期乳腺癌患者,根据手术方式的不同进行分组,行保乳联合前哨淋巴结活检手术的79例患者纳入A组,行改良根治术的79例患者纳入B组。分析比较两组患者的手术时间、出血量、拔管时间、并发症发生率、美容效果及肩关节功能恢复情况等。结果与B组相比,A组的手术时间、术后住院时间、引流管拔除时间明显更短,术中出血量和总引流量均更少,差异均有统计学意义(均P <0. 05)。A组患者的并发症总发生率为3. 8%,显著低于B组患者的44. 3%,差异有统计学意义(P <0. 05)。术前,两组患者肩关节功能比较,差异无统计学意义(P> 0. 05)。与术前相比,B组术后的肩关节功能评分明显降低,且B组术后的肩关节功能评分低于A组,差异有统计学意义(P <0. 05)。A组患者对手术美容效果的总满意率为92. 4%,显著高于B组的68. 4%,差异有统计学意义(P <0. 05)。与B组相比,A组术后的物质生活状态、心理功能、社会功能和躯体功能评分均明显更高,差异均有统计学意义(均P <0. 05)。结论保乳联合前哨淋巴结活检术与改良根治术治疗早期乳腺癌均有确切疗效,但前者能够有效减少手术相关并发症发生风险,减轻肩关节功能损害,保持乳房形态,提高患者术后的生活质量。

Objective To investigate the effect of breast-conserving surgery combined with sentinel lymph node biopsy and modified radical mastectomy on postoperative recovery and quality of life in patients with early stage breast cancer. Methods A total of 158 patients with early stage breast cancer who admitted to People’s Hospital of Neixiang County were selected from July 2015 to July 2018. They were divided into two groups based on the surgery they received. Seventy-nine patients who underwent breast-conserving surgery combined with sentinel lymph node biopsy were included in group A. The rest 79 patients who underwent modified radical mastectomy were included in group B. Operation time,bleeding volume,time to extubation,incidence of complications,cosmetic effect,and recovery of shoulder function were compared between the two groups. Results Compared with the group B,the operation time,postoperative length of hospital stay,and time to drainage tube removal was significantly shorter and intraoperative blood loss and overall drainage volume were significantly lower in group A( all P < 0. 05). The overall incidence of complications was 3. 8% in group A,which was lower than 44. 3% of group B( P < 0. 05). There was no significant difference in shoulder function between the groups before the surgery( P > 0. 05). After the surgery,scores of shoulder function decreased in group B and the scores were lower in group B than in group A( P <0. 05). Patient satisfaction with cosmetic effect was 92. 4% in group A which was higher than 68. 4% of group B( P < 0. 05). Scores postoperative material life state,psychological function,social function and physical function were significantly higher in group A than in group B( all P < 0. 05). Conclusion Breastconserving surgery combined with sentinel lymph node biopsy shows comparable efficacy in the treatment of early stage breast cancer with modified radical mastectomy. Comparatively,the former can effectively reduce the risk of surgery-related complications,shoulder joint function damage,maintain breast shape,and improve quality of life after the surgery.