保乳术联合前哨淋巴结活检在老年乳腺癌患者术后的效果
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摘要
为探讨治疗老年乳腺癌患者运用保乳术联合前哨淋巴结活检手术的临床效果,本研究采用随机数字法回顾性分析了自2015年1月至2017年10月我院收治的120例老年乳腺癌手术患者的临床资料,在采用常规根治术治疗的患者中选择60例设为对照组,采用保乳术联合前哨淋巴结活检手术治疗的患者中选择60例作为观察组,对比2组患者术中、术后临床指标及患者满意度。观察组患者术中出血量、手术时间、拔管时间、住院时间均低于对照组,差异有统计学意义(p<0.05);在并发症发生率方面,观察组远低于对照组(3.75%vs 33.72%),差异有统计学意义(p<0.05);观察组与对照组术后Neer肩关节功能评分分别为(87.34±21.12)分、(75.12±22.65)分,观察组术后屈曲、外展、后伸、外旋、内旋功能的活动度均较对照组明显升高,差异有统计学意义(p<0.05);术后半年随访结果显示,观察组满意度(90.0%)显著高于对照组(58.3%),差异有统计学意义(p<0.05)。研究结果表明,联合手术治疗老年性乳腺癌患者术中指标较好,术后指标以及生活质量等均有明显优势,同时具有更低的并发症发生率,安全系数较高。
In order to research the the clinical effect of breast conserving surgery combined with sentinel lymph node biopsy in the treatment of elderly patients with breast cancer, 120 cases of old patients with breast cancer admitted and treated in our hospital from June 2015 to October 2017 were randomly divided into two groups with60 cases in each. The control group were treated with traditional radical operation, while the observation group were treated with breast conserving therapy and sentinel lymph node biopsy operation, and the clinical indexes were compared between the two groups. After 6-month follow-up, the cosmetic result after operation was compared between the two groups. The intraoperative blood loss, operative time, extubation time and hospital stay in the observation group(3.75%) were lower than those in the control group(p<0.05). The incidence of complications in the observation group was much lower than that in the control group(33.72%), the difference was statistically significant.(p<0.05). The activity degree of buckling, outreach, stretching, extorsion and internal rotation function were obviously higher in observation group than that in the control group, and the satisfactory rate in the observaton group was higher than that in the control group(90.0%vs 58.3%)(p<0.05). The results showed that the combination operation was better in the treatment of senile breast cancer, the postoperative index and the quality of life had obvious advantages, and the incidence of complications was lower, and the safety factor was higher.
In order to research the the clinical effect of breast conserving surgery combined with sentinel lymph node biopsy in the treatment of elderly patients with breast cancer, 120 cases of old patients with breast cancer admitted and treated in our hospital from June 2015 to October 2017 were randomly divided into two groups with60 cases in each. The control group were treated with traditional radical operation, while the observation group were treated with breast conserving therapy and sentinel lymph node biopsy operation, and the clinical indexes were compared between the two groups. After 6-month follow-up, the cosmetic result after operation was compared between the two groups. The intraoperative blood loss, operative time, extubation time and hospital stay in the observation group(3.75%) were lower than those in the control group(p<0.05). The incidence of complications in the observation group was much lower than that in the control group(33.72%), the difference was statistically significant.(p<0.05). The activity degree of buckling, outreach, stretching, extorsion and internal rotation function were obviously higher in observation group than that in the control group, and the satisfactory rate in the observaton group was higher than that in the control group(90.0%vs 58.3%)(p<0.05). The results showed that the combination operation was better in the treatment of senile breast cancer, the postoperative index and the quality of life had obvious advantages, and the incidence of complications was lower, and the safety factor was higher.
引文
Fu J.Q.,Yan J.L.,Tian J.Z.,and Wang X.D.,2016,The influence of breast-conserving surgery combined with sentinel node biopsy on the postoperative recovery status and complications of the older patients with breast cancer,Zhonghua Quanke Yixue(Chinese Journal of General Practice),14(3):407-408(傅家清,闫金亮,田景中,王晓东,2016,保乳联合前哨淋巴结活检手术对老年乳腺癌患者术后恢复状况及并发症的影响,中华全科医学,14(3):407-408)
Qiu P.F.,Zhao R.R.,Cong B.B.,Yang G.R.,Liu Y.B.,Chen P.,Sun X.,Wang C.J.,and Wang Y.S.,2016,Internal mammary sentinel lymph node biopsy in breast cancer:accurate stga ing and individualized treatment,Zhonghua Zhongliu Zazhi(Chinese Journal of Oncology),38(1):42-47(邱鹏飞,赵荣荣,丛斌斌,杨国仁,刘雁冰,陈鹏,孙晓,王春建,王永胜,2016,乳腺癌内乳区前哨淋巴结活检术对淋巴分期和个体化治疗的影响,中华肿瘤杂志,38(1):42-47)
Sun X.,Cong B.B.,Qiu P.F.,Zhang Z.P.,Zhou Z.B.,Liu Y.B.,Chen P.,Zhao T.,Wang C.J.,and Wang Y.J.,2015,Internal mammary sentinel lymph node biopsy in breast cancer patients with clinically positive axillary lymph nodes,Zhongguo Zhongliu Linchuang(Chinese Journal of Clinical Oncology),42(6):341-344(孙晓,丛斌斌,邱鹏飞,张朝蓬,周正波,刘雁冰,陈鹏,赵桐,王春建,王永胜,2015,临床腋窝淋巴结阳性乳腺癌患者内乳区前哨淋巴结活检术研究,中国肿瘤临床,42(6):341-344)
Wang Z.H.,Teng C.S.,Ge Z.C.,Zhang H.M.,Yuan Z.,Gao Y.G.,Wei J.A.,Zhang Z.T.,and Qu X.,2015,Combination of endoscopic subcutaneous mastectomy and endoscopic sentinel lymph node biopsy in breast cancer,Linchuang He Shiyanyixue Zazhi(Journal of Clinical and Experimental Medicine),1(15):1297-1301(王子函,滕长胜,葛智成,张慧明,苑著,高银光,尉建安,张忠涛,屈翔,2015,全腔镜乳房皮下腺体切除术加腔镜前哨淋巴结活检术治疗乳腺癌的临床应用,临床和实验医学杂志,1(15):1297-1301)
Wu J.,Zhao G.,Cui F.Q.,Meng Q.J.,Fan J.,Wang Y.,Yi J.,Ling R.,and Li N.L.,2016,The clinical value of sentinel lymph node biopsy in combination with preoperative ultrasound in the diagnosis of axillary lymph node dissection in patients of senile breast cancer,Xiandai Zhongliu Yixue(Journal of Modern Oncology),24(4):551-554(巫姜,赵戈,崔风强,孟庆杰,樊菁,王廷,易军,凌瑞,李南林,2016,前哨淋巴结活检联合术前超声在老年乳腺癌腋窝淋巴结清扫中的价值,现代肿瘤医学,24(4):551-554)
Zhang F.,Song Z.J.,Wang C.T.,Chen N.,and Han P.H.,2015,Clinical efficacy analysis of breast conserving surgery combined with sentinel lymph node biopsy on triple negative breast cancer,Xiandai Shengwu Yixue Jinzhan(Progress in Modern Biomedicine),15(27):5260-5262(张锋,宋张骏,汪存涛,陈楠,韩丕华,2015,三阴乳腺癌保乳术联合前哨淋巴结活检的临床疗效分析,现代生物医学进展,15(27):5260-5262)
Zhang P.S.,Luo Y.F.,Yu J.L.,Fang C.H.,Shi F.J.,and Deng J.W.,2016,Application of digital 3D technique combined with nanocarbon-aided navigation in endoscopic sentinel lymph node biopsy for breast cancer,Nanfang Yike Daxue Xuebao(Journal of Southern Medical University),36(8):1129-1133(张普生,罗云峰,俞金龙,方驰华,史福军,邓鉴文,2016,数字三维技术联合纳米碳辅助导航在乳腺癌腔镜前哨淋巴结活检手术中的应用,南方医科大学学报,36(8):1129-1133)
Zhang S.,Zeng F.Y.,Tang W.,Huang Y.,Huang Y.,and Zhang X.L.,2016,Breast-conserving united with sentinel lymph node biopsy for elderly patients with breast cancer and the impact on quality of life after surgery and cosmetic results,Shiyong Aizheng Zazhi(The Practical Journal of Cancer),1(1):124-127(张珊,曾繁余,唐巍,黄颖,黄玥,张显岚,2016,保乳联合前哨淋巴结活检对老年乳腺癌患者的疗效及对术后生活质量及美容效果的影响,实用癌症杂志,1(1):124-127)
Qiu P.F.,Zhao R.R.,Cong B.B.,Yang G.R.,Liu Y.B.,Chen P.,Sun X.,Wang C.J.,and Wang Y.S.,2016,Internal mammary sentinel lymph node biopsy in breast cancer:accurate stga ing and individualized treatment,Zhonghua Zhongliu Zazhi(Chinese Journal of Oncology),38(1):42-47(邱鹏飞,赵荣荣,丛斌斌,杨国仁,刘雁冰,陈鹏,孙晓,王春建,王永胜,2016,乳腺癌内乳区前哨淋巴结活检术对淋巴分期和个体化治疗的影响,中华肿瘤杂志,38(1):42-47)
Sun X.,Cong B.B.,Qiu P.F.,Zhang Z.P.,Zhou Z.B.,Liu Y.B.,Chen P.,Zhao T.,Wang C.J.,and Wang Y.J.,2015,Internal mammary sentinel lymph node biopsy in breast cancer patients with clinically positive axillary lymph nodes,Zhongguo Zhongliu Linchuang(Chinese Journal of Clinical Oncology),42(6):341-344(孙晓,丛斌斌,邱鹏飞,张朝蓬,周正波,刘雁冰,陈鹏,赵桐,王春建,王永胜,2015,临床腋窝淋巴结阳性乳腺癌患者内乳区前哨淋巴结活检术研究,中国肿瘤临床,42(6):341-344)
Wang Z.H.,Teng C.S.,Ge Z.C.,Zhang H.M.,Yuan Z.,Gao Y.G.,Wei J.A.,Zhang Z.T.,and Qu X.,2015,Combination of endoscopic subcutaneous mastectomy and endoscopic sentinel lymph node biopsy in breast cancer,Linchuang He Shiyanyixue Zazhi(Journal of Clinical and Experimental Medicine),1(15):1297-1301(王子函,滕长胜,葛智成,张慧明,苑著,高银光,尉建安,张忠涛,屈翔,2015,全腔镜乳房皮下腺体切除术加腔镜前哨淋巴结活检术治疗乳腺癌的临床应用,临床和实验医学杂志,1(15):1297-1301)
Wu J.,Zhao G.,Cui F.Q.,Meng Q.J.,Fan J.,Wang Y.,Yi J.,Ling R.,and Li N.L.,2016,The clinical value of sentinel lymph node biopsy in combination with preoperative ultrasound in the diagnosis of axillary lymph node dissection in patients of senile breast cancer,Xiandai Zhongliu Yixue(Journal of Modern Oncology),24(4):551-554(巫姜,赵戈,崔风强,孟庆杰,樊菁,王廷,易军,凌瑞,李南林,2016,前哨淋巴结活检联合术前超声在老年乳腺癌腋窝淋巴结清扫中的价值,现代肿瘤医学,24(4):551-554)
Zhang F.,Song Z.J.,Wang C.T.,Chen N.,and Han P.H.,2015,Clinical efficacy analysis of breast conserving surgery combined with sentinel lymph node biopsy on triple negative breast cancer,Xiandai Shengwu Yixue Jinzhan(Progress in Modern Biomedicine),15(27):5260-5262(张锋,宋张骏,汪存涛,陈楠,韩丕华,2015,三阴乳腺癌保乳术联合前哨淋巴结活检的临床疗效分析,现代生物医学进展,15(27):5260-5262)
Zhang P.S.,Luo Y.F.,Yu J.L.,Fang C.H.,Shi F.J.,and Deng J.W.,2016,Application of digital 3D technique combined with nanocarbon-aided navigation in endoscopic sentinel lymph node biopsy for breast cancer,Nanfang Yike Daxue Xuebao(Journal of Southern Medical University),36(8):1129-1133(张普生,罗云峰,俞金龙,方驰华,史福军,邓鉴文,2016,数字三维技术联合纳米碳辅助导航在乳腺癌腔镜前哨淋巴结活检手术中的应用,南方医科大学学报,36(8):1129-1133)
Zhang S.,Zeng F.Y.,Tang W.,Huang Y.,Huang Y.,and Zhang X.L.,2016,Breast-conserving united with sentinel lymph node biopsy for elderly patients with breast cancer and the impact on quality of life after surgery and cosmetic results,Shiyong Aizheng Zazhi(The Practical Journal of Cancer),1(1):124-127(张珊,曾繁余,唐巍,黄颖,黄玥,张显岚,2016,保乳联合前哨淋巴结活检对老年乳腺癌患者的疗效及对术后生活质量及美容效果的影响,实用癌症杂志,1(1):124-127)