基于前哨淋巴结活检的保乳术与改良根治术在早期乳腺癌治疗中的对比研究

Comparative Study of Breast Conserving Surgery Based on Sentinel Lymph Node Biopsy and Modified Radical Mastectomy in the Treatment of Early Breast Cancer

目的:探讨基于前哨淋巴结活检的保乳术与改良根治术在早期乳腺癌治疗中的效果与安全性。方法:选取2010年8月-2015年7月广州市花都区妇幼保健院(胡忠医院)收治的136例早期乳腺癌患者,按照随机数字表法将患者分为对照组和观察组,每组68例。对照组给予综合治疗联合改良根治术,观察组给予综合治疗联合基于前哨淋巴结活检的保乳术。比较两组手术指标、炎症因子、美容效果、并发症发生情况及预后。结果:观察组手术时间、腋下引流管拔除时间均短于对照组,术中出血量、术后腋下引流量均少于对照组(P<0.05)。术前,两组降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)水平比较,差异均无统计学意义(P>0.05);术后3 d,两组PCT、TNF-α水平均高于术前,且观察组均低于对照组(P<0.05)。观察组美容效果优良率为95.59%,高于对照组的33.82%(P<0.05)。观察组并发症发生率为4.41%,低于对照组的19.11%(P<0.05)。两组总体生存率比较,差异无统计学意义(P>0.05)。结论:基于前哨淋巴结活检的保乳术与改良根治术相比对患者创伤小、应激性小、美容效果好且术后并发症发生率低,总体生存率无明显差异。

Objective:To investigate the efficacy and safety of breast conserving surgery based on sentinel lymph node biopsy and modified radical mastectomy based on sentinel lymph node biopsy in the treatment of early breast cancer.Method:A total of 136 patients with early breast cancer who were admitted to Guangzhou Huadu Maternal and Child Health Hospital(Huzhong hospital) from August 2010 to July 2015 were selected,they were divided into control group and observation group according to random number table,68 cases in each group.The control group was given comprehensive treatment combined with modified radical mastectomy,and the observation group was given comprehensive treatment combined with breast conserving surgery based on sentinel lymph node biopsy.The surgical indicators,inflammatory indicators,cosmetic effects,complications and prognosis were compared between two groups.Result:The surgical time and axillary drainage tube removal time in the observation group were shorter than those in the control group,and the intraoperative blood loss and postoperative axillary drainage volume in the observation group were less than those in the control group(P<0.05).Before surgery,there were no significant differences in procalcitonin(PCT),tumor necrosis factor-α(TNF-α) levels between two groups(P>0.05);3 d after surgery,the levels of PCT and TNF-α in both groups were higher than those before surgery,and those in the observation group were lower than those in the control group(P<0.05).The excellent and good rate of beauty effect in the observation group was 95.59%,which was higher than 33.82% in the control group(P<0.05).The incidence of complications in the observation group was 4.41%,which was lower than 19.11% in the control group(P<0.05).There was no significant difference in overall survival rate between two groups(P>0.05).Conclusion:Compared with modified radical mastectomy,breast conserving surgery based on sentinel lymph node biopsy has less trauma,less stress,better aesthetic effect,lower incidence of postoperative complications and similar overall survival rate.