前哨淋巴结活检在乳腺癌手术中的临床意义研究

Clinical significance of sentinel lymph node biopsy in breast cancer surgery

目的探究乳腺癌改良根治术与保留腋窝淋巴结的乳腺癌手术的临床疗效。方法回顾性分析2017年4月至2019年4月手术治疗的经前哨淋巴结活检为阴性早期乳腺癌患者共计61例。根据术式不同将患者分为两组,改良组35例患者行乳腺癌改良根治术,保腋组26例患者行保留腋窝淋巴结的乳腺癌切除手术。临床数据分析使用统计学软件SPSS 24.0,围手术期指标、QLQ-BR23评分等计量资料采用(x±s)表示,组间比较采用独立样本t检验;术后并发症等计数资料采用χ^(2)检验;Kaplan-Meier法绘制无病生存曲线,Log-rank检验分析生存率差异。以P<0.05为差异有统计学意义。结果保腋组手术时间、术中出血量、拔管时间及引流量均少于改良组(P<0.05);改良组并发症发生率为34.2%明显多于保腋组为11.5%(P<0.05);两组患者术后1年QLQ-BR23评分比较,保腋组在形体评分、副反应及上肢症状评分中均明显优于改良组(P<0.05);术后随访14~38个月,中位随访时间27个月。随访期间,两组无病生存率比较差异无统计学意义(P>0.05)。结论前哨淋巴结阴性的早期乳腺癌患者行保腋根治术,可减少术后并发症的发生,改善生活质量,且对远期预后无明显影响,值得临床应用。

Objective To investigate the clinical effect of modified radical mastectomy and axillary lymph node preservation for breast cancer.Methods A total of 61 patients with negative early breast cancer treated surgical treatment between April 2017 and April 2019.The patients were divided into two groups according to different surgical methods:35 patients in the improved group received improved radical mastectomy for breast cancer,and 26 patients in the axillary-preserving group received axillary lymph node preserving mastectomy for breast cancer.Clinical data analysis using the statistical software SPSS 24.0,perioperative indicators and QLQ-BR23 score measurement data used (x±s) said,comparison between groups use independent sample t test;The statistical data of postoperative complications were tested byχ^(2) test.The disease-free survival curve was ploted by Kaplan-Meier method,and the difference in survival rate was analyzed by Log-rank test.P<0.05 was considered statistically significant.Results The operative time,intraoperative blood loss,extubation time and drainage volume in axil-preserving group were less than those in improved group(P<0.05).The complication rate of improved group(34.2%)was significantly higher than that of axillary protection group(11.5%)(P<0.05).Comparison of The QLQ-BR23 scores one year after operation showed that the axillary preservation group was significantly better than the preservation group in body shape assessment,side effects and upper limb symptoms scores,with statistically significant differences(P<0.05).The follow-up period ranged from 14~38 months,and the median follow-up time was 27 months.There was no significant difference in disease-free survival rate between the two groups(P>0.05).Conclusion Axillary preservation radical mastectomy for sentinel lymph node negative patients with early-stage breast cancer can reduce the incidence of postoperative complications,improve the quality of life,and has no significant impact on the long-term prognosis,which is worthy of clinical application.