乳腺癌保乳术SLNB阴性患者未行腋窝淋巴结清扫的效果观察

Observation the impact of omitting axillary lymphatic dissection in SLNB-negative patients undergoing breast-conserving mastectomy for breast cancer

目的观察早期浸润性乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)阴性患者在保乳术中未行腋窝淋巴结清扫(axillary lymph node dissection,ALND)的临床效果,为提高患者生存质量提供依据。方法依据术中是否进行淋巴结清扫,将110例早期浸润性乳腺癌SLNB阴性患者分为对照组50例(行常规腋窝淋巴结清扫)和观察组60例(未行腋窝淋巴结清扫)。比较两组患者的手术相关情况、术后并发症、术后1年复发率、临床疗效及生存质量。结果观察组的手术用时、拔管时间,术后引流量、术中出血量均少于对照组,差异有统计学意义(P<0.05);对照组的治疗总有效率(76.00%)和观察组(73.33%)差异没有统计学意义(χ^(2)=0.102,P=0.749)。术后随访1年,对照组并发症发生率(22.00%)高于观察组(3.33%),差异有统计学意义(χ^(2)=9.119,P=0.003);两组复发率差异无统计学意义(P>0.05)。治疗后,观察组的功能、症状评分低于对照组,总生存质量评分高于对照组,差异均有统计学意义(P<0.05)。结论早期浸润性乳腺癌SLNB阴性患者在保乳术中未进行ALND,有助于降低并发症发生率,提高患者生存质量,且治疗有效性与ALND患者相同。

Objective To examine the clinical results of patients diagnosed with early invasive breast cancer,who have undergone breast-conserving surgery without axillary lymph node dissection(ALND)despite having negative sentinel lymph node biopsy(SLNB),and to establish a foundation for improving the quality of patient survival.Methods A total of 110 SLNB-negative patients with early invasive breast cancer were divided into two groups based on whether they received axillary lymph node dissection during the operation:the control group(50 patients who underwent routine axillary lymph node dissection)and the observation group(60 patients who did not undergo axillary lymph node dissection).The surgery-related data,postoperative complications,1-year recurrence rate,clinical efficacy,and survival quality were compared between the two groups.Results The duration of the operation,the time for extubation,the volume of postoperative drainage,and the amount of intraoperative blood loss were all significantly lower in the observation group in comparison to the control group,as evidenced by statistical analysis(P<0.05).However,no significant difference in the overall effectiveness of treatment was observed between the control group(76.00%)and the observation group(73.33%)(χ^(2)=0.102,P=0.749).After a one-year follow-up,the occurrence of postoperative complications was higher in the control group(22.00%)than in the observation group(3.33%),and the distinction was statistically significant(χ^(2)=9.119,P=0.003).There was no significant variation in the recurrence rate between the two groups(P>0.05).Following the treatment,the observation group showed statistically significant improvements in function and symptom scores compared to the control group.In addition,their total survival quality scores were higher than those of the control group(P<0.05).Conclusions The omission of ALND in patients with negative SLNB and early invasive breast cancer undergoing breast-conserving surgery is beneficial in decreasing complication rates and enhancing patients'quality of life.Additionally,treatment efficacy is equivalent to those who received ALND.