保乳手术联合认知行为干预治疗乳腺癌

Exploration on the effect of breast-conserving surgery combined with cognitive behavioral intervention on breast cancer patients

目的探讨保乳手术联合认知行为干预对乳腺癌患者免疫功能及心理应激反应的影响。方法选择乳腺癌患者168例,通过随机数表法分为观察组与对照组,各84例。观察组采用保乳手术进行治疗,对照组采用乳腺癌Patey改良根治术进行治疗,2组治疗期间均实施认知行为干预,均连续干预至出院,并随访1年。比较2组手术指标、治疗依从性、治疗前后心理应激反应、免疫功能及随访期间并发症发生情况。结果观察组切口长度及手术时间短于对照组,术中出血量低于对照组(P<0.05)。观察组治疗依从率(95.24%,80/84)高于对照组(82.14%,69/84)(P<0.05)。治疗后,2组HAMA、HAMD评分及全血CD8^(+)水平较治疗前降低,观察组低于对照组(P<0.05);2组全血CD4^(+)、CD4^(+)/CD8^(+)水平较治疗前升高,观察组高于对照组(P<0.05)。随访期间,2组并发症发生率比较差异不显著(P>0.05)。结论保乳手术联合认知行为干预可明显改善乳腺癌患者手术指标,减轻心理应激反应,改善免疫功能,提高治疗依从性,且安全性好。

Objective To explore the ef fect of breast-conserving surgery combined with cognitive behavioral intervention on the immune function and psychological stress response of breast cancer patients.Methods A total of 168 breast cancer patients were selected as the research subjects and randomly divided into an observation group and a control group,with 84 cases in each group.The observation group was treated with breast-conserving surgery,while the control group was treated with modified Patey’s radical mastectomy for breast cancer.A cognitive behavioral intervention was performed in both groups during the treatment period,and continued until their discharge,when patients were followed up for one year.Their surgical indicators,treatment compliance,psychological stress response before and after treatment,the immune function and occurrence of complications during the follow-up were compared between the two groups.Results The incision length and operation time in the observation group were shorter than those in the control group,and the intraoperative blood loss was lower(P<0.05).The treatment compliance rate of the observation group(95.24%,80/84)was higher than that of the control group(82.14%,69/84)(P<0.05).After treatment,the HAMA,HAMD scores and CD8^(+)levels of whole blood in the two groups were lower than before treatment,and the observation group was lower than the control group(P<0.05),while the CD4^(+) and CD4^(+)/CD8^(+) levels in whole blood were higher than before treatment,and the observation group was higher than the control Group(P<0.05).During the follow-up period,there was no signifi cant dif ference in the incidence of complications between the observation group and the control group(P>0.05).Conclusion Breast-conserving surgery combined with cognitive behavioral intervention can signifi cantly improve surgical indicators of breast cancer patients,reduce their psychological stress response,improve their immune function and treatment compliance,with a good safety.