保留乳头乳晕的乳腺癌改良根治术对患者细胞免疫功能及甲状腺激素水平的影响
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摘要
目的观察保留乳头乳晕的乳腺癌改良根治术对乳腺癌患者细胞免疫功能及甲状腺激素水平的影响。方法选取2013年3月—2015年3月收治的乳腺癌112例,根据治疗方式分为观察组和对照组,每组56例。对照组给予传统乳腺癌改良根治术,观察组给予保留乳头乳晕乳腺癌改良根治术。观察治疗后2组临床疗效、预后、T细胞亚群及甲状腺激素水平变化情况。结果观察组治疗后美容效果优良率高于对照组(P <0. 01)。2组治疗后生活质量各维度评分均高于治疗前,且观察组高于对照组(P <0. 05,P <0. 01)。2组治疗后CD8+水平高于治疗前,血清CD4+与CD4+/CD8+水平低于治疗前(P <0. 05,P <0. 01);观察组CD8+水平低于对照组,血清CD4+与CD4+/CD8+水平高于对照组(P <0. 05,P <0. 01)。2组治疗后血清游离三碘甲腺原氨酸和血清游离甲状腺素水平高于治疗前,且观察组高于对照组(P <0. 05)。结论保留乳头乳晕的乳腺癌改良根治术临床效果较好,可提高患者术后生活质量,改善机体细胞免疫功能和甲状腺激素水平,降低术后复发率。
Objective To investigate effects of modified radical mastectomy with keeping nipple and areola papillaris on cellular immune function and thyroid hormone level in patients with breast cancer. Methods A total of 112 breast cancer patients admitted during March 2015 and March 2017 were divided into observation group and control group(n = 56 in each group) according to different treatment methods. Control group was treated with modified radical mastectomy,while observation group was treated with modified radical mastectomy with keeping nipple and areola papillaris.Clinical efficacy,prognosis,changes of T cell subsets and thyroid hormone level after treatment were observed in the two groups. Results After treatment,good rate of cosmetic result in observation group was significantly higher than that in control group(P < 0. 01); scores of life quality were significantly higher than those before treatment in two groups,and the scores in observation group were significantly higher than those in control group(P < 0. 05,P < 0. 01). After treatment,CD8 + levels were significantly higher,while serum CD4 + and CD4 +/CD8 + levels were significantly lower than those before treatment in two groups(P < 0. 05,P < 0. 01); in observation group,CD8 + level was significantly lower,while serum CD4 + and CD4 +/CD8 + levels were significantly higher than those in control group(P < 0. 05).After treatment,serum free triiodothyronine(FT3) and free(unbound) thyroxin(e)(FT4) levels were significantly higher than those before treatment in two groups,and the levels in observation group were significantly higher than those in control group(P < 0. 05,P < 0. 01). Conclusion Modified radical mastectomy with keeping nipple and areola papillaris may achieve good effectiveness,improve quality of life,immune function of the body and thyroid hormone level and reduce postoperative recurrence rate.
Objective To investigate effects of modified radical mastectomy with keeping nipple and areola papillaris on cellular immune function and thyroid hormone level in patients with breast cancer. Methods A total of 112 breast cancer patients admitted during March 2015 and March 2017 were divided into observation group and control group(n = 56 in each group) according to different treatment methods. Control group was treated with modified radical mastectomy,while observation group was treated with modified radical mastectomy with keeping nipple and areola papillaris.Clinical efficacy,prognosis,changes of T cell subsets and thyroid hormone level after treatment were observed in the two groups. Results After treatment,good rate of cosmetic result in observation group was significantly higher than that in control group(P < 0. 01); scores of life quality were significantly higher than those before treatment in two groups,and the scores in observation group were significantly higher than those in control group(P < 0. 05,P < 0. 01). After treatment,CD8 + levels were significantly higher,while serum CD4 + and CD4 +/CD8 + levels were significantly lower than those before treatment in two groups(P < 0. 05,P < 0. 01); in observation group,CD8 + level was significantly lower,while serum CD4 + and CD4 +/CD8 + levels were significantly higher than those in control group(P < 0. 05).After treatment,serum free triiodothyronine(FT3) and free(unbound) thyroxin(e)(FT4) levels were significantly higher than those before treatment in two groups,and the levels in observation group were significantly higher than those in control group(P < 0. 05,P < 0. 01). Conclusion Modified radical mastectomy with keeping nipple and areola papillaris may achieve good effectiveness,improve quality of life,immune function of the body and thyroid hormone level and reduce postoperative recurrence rate.
引文
[1]黄佳鹏,庄亚强,覃舒婷,等.保留皮肤的青年乳腺癌改良根治术后即刻乳房再造与改良根治术的比较分析[J].中国肿瘤临床,2016,43(3):100-104.
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[8]张国旭,武晓丹,王秋,等.18F-FDG PET/CT与血清肿瘤标志物在乳腺癌术后随访过程中相关性研究[J].创伤与急危重病医学,2017,5(6):378-381.
[9]尚峰,阎英,徐莹,等.早期乳腺癌保乳术后应用记忆热塑网膜固定方式在螺旋断层放射治疗中摆位误差分析[J].创伤与急危重病医学,2017,5(5):284-291.
[10]俞晓立,郭小毛.保留乳头乳晕复合体的乳腺癌切除术中放疗的地位探讨[J].中国癌症杂志,2016,26(5):378-382.
[11]阮淼,水若鸿.乳腺癌乳头乳晕复合体受侵犯的相关临床病理因素[J].中国癌症杂志,2016,26(5):361-366.
[12]刘梦友,金功圣,陈晨,等.保留乳头乳晕乳腺癌改良根治术后即刻扩展型背阔肌乳房再造术的临床应用[J].中国普通外科杂志,2018,27(5):601-607.
[13]王玮,朱丽.保留乳头乳晕复合体乳房切除术的手术切口设计[J].中国癌症杂志,2016,26(5):367-371.
[14]石国建,顾蓓,郭斌,等.乳腺癌患者行乳腺重建手术效果的影响因素研究[J].西北国防医学杂志,2016,37(11):715-717.
[15]曹一鸣,韦长元,莫军扬,等.乳腺癌乳房重建术临床疗效及相关因素分析[J].中华普通外科杂志,2016,31(2):126-129.
[16]佘青,李有怀,程永刚,等.全腔镜乳房皮下腺体切除术联合腔镜前哨淋巴结活检术治疗早中期乳腺癌的技巧探讨[J].川北医学院学报,2016,31(5):756-758.
[17]何力,杨帆.乳腺癌改良根治术后乳房重建对患者应激反应、社会支持及生命质量的影响[J].解放军医药杂志,2016,28(12):69-72.
[18]王芳,杜攀,刘磊,等.乳腺癌改良根治术与保乳术对乳腺癌患者存活质量、社会适应性及心理状态的影响[J].实用预防医学,2016,23(10):1236-1238.
[19]王常珺,姚儒,周易冬,等.单切口环乳晕入路保留乳头乳晕乳腺癌改良根治术联合同期乳腺扩张器植入术的应用分析[J].中华内分泌外科杂志,2017,11(2):92-96.
[20]王萌萌,王京,华建芬,等.保留乳头乳晕的乳腺癌改良根治术联合Ⅰ期假体植入与传统乳腺癌改良根治术的临床疗效对比[J].中国妇幼保健,2017,32(23):6040-6043.
[21]李文斌,汤晗,邹洁雅,等.保留乳头乳晕的乳腺癌改良根治术治疗乳腺癌的安全性[J].国际肿瘤学杂志,2017,44(1):49-52.
[2]刘学敏,顾瑞香,王海强,等.保留乳头乳晕复合体的乳腺癌术后即刻乳房重建术[J].中国美容整形外科杂志,2016,27(4):212-214.
[3]王永南,张安秦.保留乳头乳晕的乳腺癌改良根治术的术后并发症[J].国际外科学杂志,2016,43(3):201-205.
[4]崔智淼,骆成玉,李鑫,等.乳腔镜辅助保留NAC乳腺癌改良根治术并假体植入Ⅰ期成形的临床研究[J].首都医科大学学报,2016,37(3):341-345.
[5]柴丽君,张学慧.前锯肌肌瓣在乳腺癌改良根治术后即刻乳房再造中的应用[J].中国修复重建外科杂志,2017,29(9):1098-1101.
[6]孔令禹,辛智芳.保乳头乳晕全乳切除与标准改良根治术后即刻乳房重建的临床对照研究[J].中华肿瘤防治杂志,2016,23(17):1184-1188.
[7] Kijima Y,Yoshinaka H,Hirata M,et al. Therapeutic mammoplasty combining partial mastectomy with nipple-areola grafting for patients with early breast cancer:a case series[J]. Surg Today,2016,46(10):1187-1195. DOI:10. 1007/s00595-015-1294-0.
[8]张国旭,武晓丹,王秋,等.18F-FDG PET/CT与血清肿瘤标志物在乳腺癌术后随访过程中相关性研究[J].创伤与急危重病医学,2017,5(6):378-381.
[9]尚峰,阎英,徐莹,等.早期乳腺癌保乳术后应用记忆热塑网膜固定方式在螺旋断层放射治疗中摆位误差分析[J].创伤与急危重病医学,2017,5(5):284-291.
[10]俞晓立,郭小毛.保留乳头乳晕复合体的乳腺癌切除术中放疗的地位探讨[J].中国癌症杂志,2016,26(5):378-382.
[11]阮淼,水若鸿.乳腺癌乳头乳晕复合体受侵犯的相关临床病理因素[J].中国癌症杂志,2016,26(5):361-366.
[12]刘梦友,金功圣,陈晨,等.保留乳头乳晕乳腺癌改良根治术后即刻扩展型背阔肌乳房再造术的临床应用[J].中国普通外科杂志,2018,27(5):601-607.
[13]王玮,朱丽.保留乳头乳晕复合体乳房切除术的手术切口设计[J].中国癌症杂志,2016,26(5):367-371.
[14]石国建,顾蓓,郭斌,等.乳腺癌患者行乳腺重建手术效果的影响因素研究[J].西北国防医学杂志,2016,37(11):715-717.
[15]曹一鸣,韦长元,莫军扬,等.乳腺癌乳房重建术临床疗效及相关因素分析[J].中华普通外科杂志,2016,31(2):126-129.
[16]佘青,李有怀,程永刚,等.全腔镜乳房皮下腺体切除术联合腔镜前哨淋巴结活检术治疗早中期乳腺癌的技巧探讨[J].川北医学院学报,2016,31(5):756-758.
[17]何力,杨帆.乳腺癌改良根治术后乳房重建对患者应激反应、社会支持及生命质量的影响[J].解放军医药杂志,2016,28(12):69-72.
[18]王芳,杜攀,刘磊,等.乳腺癌改良根治术与保乳术对乳腺癌患者存活质量、社会适应性及心理状态的影响[J].实用预防医学,2016,23(10):1236-1238.
[19]王常珺,姚儒,周易冬,等.单切口环乳晕入路保留乳头乳晕乳腺癌改良根治术联合同期乳腺扩张器植入术的应用分析[J].中华内分泌外科杂志,2017,11(2):92-96.
[20]王萌萌,王京,华建芬,等.保留乳头乳晕的乳腺癌改良根治术联合Ⅰ期假体植入与传统乳腺癌改良根治术的临床疗效对比[J].中国妇幼保健,2017,32(23):6040-6043.
[21]李文斌,汤晗,邹洁雅,等.保留乳头乳晕的乳腺癌改良根治术治疗乳腺癌的安全性[J].国际肿瘤学杂志,2017,44(1):49-52.