整形保乳手术在年轻早期乳腺癌患者中的临床疗效及对血CD19~+B细胞、NK细胞和IL-6水平的影响
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摘要
目的探讨整形保乳手术在年轻早期乳腺癌患者中的临床效果及对外周血CD19~+B细胞、自然杀伤(naturalkiller,NK)细胞和白细胞介素6(interleukin-6,IL-6)水平的影响。方法选取2016年1月至2017年12月于本院治疗的早期乳腺癌患者90例,根据手术方案分为对照组(n=45例)和观察组(n=45例),所有患者均未行术前化疗。对照组采用常规保乳手术治疗,观察组采用整形保乳手术治疗,术后对患者进行5年随访,对手术效果进行评估。记录并统计两组术中出血量、手术及住院时间、切除组织重量、最小手术切缘及最大手术切缘;采用流式细胞仪测定两组手术前后的CD19~+B细胞、NK细胞水平;采用酶联免疫吸附试验测定两组手术后IL-6水平;记录并统计两组术后血清肿、血肿、切口开裂、脂肪坏死及皮肤退缩的发生率,比较两组的临床疗效及对血CD19~+B细胞、NK细胞及IL-6水平的影响。结果观察组的手术时间、切除组织重量、最小手术切缘及最大手术切缘均大于对照组(P<0.05),而术中出血量、住院时间均小于对照组(P<0.05);两组术后血CD19~+B细胞、NK细胞及IL-6水平均低于手术前(P<0.05),观察组手术后血CD19~+B细胞、NK细胞及IL-6水平均低于对照组(P<0.05);观察组术后血清肿、血肿、切口开裂、脂肪坏死及皮肤退缩的发生率与对照组比较差异无显著性(P>0.05)。结论整形保乳手术用于年轻早期乳腺癌患者不仅能保证保乳手术切缘安全性,还能降低血CD19~+B细胞、NK细胞及IL-6水平,值得推广应用。
Objective To investigate the clinical effects of orthopedic breast-conserving surgery in young early-stage breast cancer patients and their effects on blood CD19~+B lymphocyte, NK and IL-6 levels. Method A total of 90 patients with early breast cancer admitted to hospital from January 2016 to December 2017 were selected and divided into a control group(n=45) and an observation group(n=45) according to the surgical plan. The control group was treated with conventional breast-conserving surgery. The observation group was treated with plastic breast-conserving surgery. The patients were followed for 5 years after operation and the surgical outcome was evaluated. Two groups of intraoperative blood loss, surgery and length of stay, weight of the resection tissue, minimum surgical margin, and maximum surgical margin were recorded and counted; flow cytometry was used to determine CD19~+B lymphocyte and natural killer(NK) levels before and after surgery in both groups. The enzyme-linked immunosorbent assay was used to measure the interleukin-6(IL-6) levels after surgery; the incidence of seroma, hematoma, incision, fat necrosis, and skin retraction was recorded and compared between the two groups. Clinical efficacy and effects on blood CD19~+B lymphocyte, NK and IL-6 levels. Result The operative time, resection tissue weight, minimum surgical margin, and maximum surgical margin in the observation group were all greater than those in the control group(P<0.05). The intraoperative blood loss and length of stay in the observation group were all shorter than those in the control group(P<0.05). The blood levels of CD19~+B lymphocyte, NK and IL-6 were lower in the observation group and the control group than before the operation(P<0.05). The levels of blood CD19~+B lymphocyte, NK and IL-6 in the observation group were lower than those in the control group after surgery(P<0.05); there was no significant difference in postoperative serum edema, hematoma, incision cracking, fat necrosis and skin retraction between the observation group and the control group(P>0.05). Conclusion The use of plastic surgery for breast cancer in young patients with early breast cancer can not only guarantee the margin of breast-conserving surgery, but also reduce the levels of blood CD19~+B lymphocyte, NK and IL-6. The incidence of complications is low and worthy of popularization and application.
Objective To investigate the clinical effects of orthopedic breast-conserving surgery in young early-stage breast cancer patients and their effects on blood CD19~+B lymphocyte, NK and IL-6 levels. Method A total of 90 patients with early breast cancer admitted to hospital from January 2016 to December 2017 were selected and divided into a control group(n=45) and an observation group(n=45) according to the surgical plan. The control group was treated with conventional breast-conserving surgery. The observation group was treated with plastic breast-conserving surgery. The patients were followed for 5 years after operation and the surgical outcome was evaluated. Two groups of intraoperative blood loss, surgery and length of stay, weight of the resection tissue, minimum surgical margin, and maximum surgical margin were recorded and counted; flow cytometry was used to determine CD19~+B lymphocyte and natural killer(NK) levels before and after surgery in both groups. The enzyme-linked immunosorbent assay was used to measure the interleukin-6(IL-6) levels after surgery; the incidence of seroma, hematoma, incision, fat necrosis, and skin retraction was recorded and compared between the two groups. Clinical efficacy and effects on blood CD19~+B lymphocyte, NK and IL-6 levels. Result The operative time, resection tissue weight, minimum surgical margin, and maximum surgical margin in the observation group were all greater than those in the control group(P<0.05). The intraoperative blood loss and length of stay in the observation group were all shorter than those in the control group(P<0.05). The blood levels of CD19~+B lymphocyte, NK and IL-6 were lower in the observation group and the control group than before the operation(P<0.05). The levels of blood CD19~+B lymphocyte, NK and IL-6 in the observation group were lower than those in the control group after surgery(P<0.05); there was no significant difference in postoperative serum edema, hematoma, incision cracking, fat necrosis and skin retraction between the observation group and the control group(P>0.05). Conclusion The use of plastic surgery for breast cancer in young patients with early breast cancer can not only guarantee the margin of breast-conserving surgery, but also reduce the levels of blood CD19~+B lymphocyte, NK and IL-6. The incidence of complications is low and worthy of popularization and application.
引文
[1]唐玮,刘剑仑,杨华伟,等.整形保乳术与常规保乳术在早期乳腺癌治疗中的比较分析[J].中国肿瘤临床,2016, 43(6):235-239.
[2]曹勇,罗杰,周鑫,等.肿瘤整形技术在早期乳腺癌保乳手术中的临床应用[J].中国普通外科杂志,2017, 26(5):607-613.
[3]陈军,江强.前哨淋巴结活检联合保乳手术治疗老年乳腺癌的临床疗效[J].中国老年学杂志,2016,36(24):6151-6152.
[4] Kashiwagi S, Asano Y, Goto W, et al. Using TILs to predict therapeutic effect of chemotherapy(pertuzumab, trastuzumab,docetaxel)on HER2-positive breast cancer[J]. Anticancer Res,2017,37(10):5623-5630.
[5]王子函,滕长胜,葛智成,等.单孔法全腔镜局部扩大切除术进行保乳手术的临床应用[J].首都医科大学学报,2016,37(3):336-340.
[6] De Lorenzi F, Hubner G, Rotmensz N, et al. Oncological results of oncoplastic breast-conserving surgery:long term follow-up of a large series at a single institution:a matched-cohort analysis[J].Eur J Surg Oncol, 2016, 42(1):71-77.
[7] Rietjens M, Urban CA, Rey PC et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery[J].Breast, 2007, 16(4):387-395.
[8]陈峙霖,周恩相.保乳手术后乳腺癌患者血CD19+、自然杀伤细胞、白细胞介素-6水平变化及其对乳腺癌复发的预测价值[J].中国临床医生杂志,2017,45(1):63-65.
[9]孙萍.保乳术对乳腺癌患者血清标志物、NK细胞、CD19+细胞及术后复发的影响[J].实用临床医药杂志,2018,22(15):53-56.
[10]张干林,陈迪,张佳琦,等.乳腺癌根治术后即刻乳房再造对患者术后生存率的影响[J].中华整形外科杂志,2016, 32(4):275-279.
[11]张普生,王立坤,罗云峰,等.三维可视技术指导腔镜乳腺癌保乳并转移背阔肌瓣重建乳房[J].南方医科大学学报,2017,37(8):1131-1135.
[12]张丝媛,铁剑,于会明,等.乳腺癌保乳术后放疗瘤床二维电子线与三维调强补量的疗效比较[J].中华放射医学与防护杂志,2017,37(5):345-351.
[13]夏重升,李苗苗,范敏,等.早期乳腺癌保乳术后瘤床同步加量调强放疗的临床观察[J].中华放射医学与防护杂志,2017, 37(2):119-124.
[14]杨昭志,俞晓立,梅欣,等.早期乳腺癌保乳术后全乳IMRT及瘤床大分割同期加量的临床Ⅱ期研究[J].中华放射肿瘤学杂志,2016,25(7):703-707.
[15]钟秋子,荣庆林,唐玉,等.Ⅰ-Ⅱ期乳腺癌保乳术后放疗的临床疗效及预后分析[J].中华放射肿瘤学杂志,2018, 27(2):165-169.
[16] Valente SA, Tendulkar RD, Cherian S, et al. TARGIT-R(Retrospective):North American experience with intraoperative radiation using low-kilovoltage X-rays for breast cancer[J]. Annals of Surgical Oncology,2016, 23(9):1-7.
[17]陈旭明,郭巨江,翁一尹,等.超声引导下麦默通活检术在多发乳腺病灶中诊断早期乳腺癌的意义[J].中国普通外科杂志,2016,25(5):773-775.
[18]冯莉莉,周红悦,麻增林.动态增强扫描MR及弥散加权MRI在监测乳腺癌保乳术后肿瘤复发中的价值[J].广东医学,2017, 38(10):1561-1564.
[19]林金勇,胡彩容,张秀春,等.Tomo Direct和Tomo Helical技术在左侧乳腺癌保乳术后放疗中的剂量学比较[J].中华放射医学与防护杂志,2017,37(3):216-221.
[20] Fayanju OM, Buchholz TA, Hunt KK. Postmastectomy radiation treatment rates as a quality measure:an opportunity for compliance through collaboration[J]. Ann Surg Oncol, 2016, 23(8):2377-2379.
[21]钱钧强,张霄蓓.乳腺癌患者细胞周期蛋白依赖性激酶5调节亚基相关蛋白2表达与新辅助化疗疗效的相关性研究[J].中国全科医学,2016,19(35):4346-4349.
[22]刘和荣,周厚吾,沈文华.乳腺癌保乳+前哨淋巴结活检术的应用效果评价与技术探讨[J].广东医学,2017, 38(s1):69-71.
[2]曹勇,罗杰,周鑫,等.肿瘤整形技术在早期乳腺癌保乳手术中的临床应用[J].中国普通外科杂志,2017, 26(5):607-613.
[3]陈军,江强.前哨淋巴结活检联合保乳手术治疗老年乳腺癌的临床疗效[J].中国老年学杂志,2016,36(24):6151-6152.
[4] Kashiwagi S, Asano Y, Goto W, et al. Using TILs to predict therapeutic effect of chemotherapy(pertuzumab, trastuzumab,docetaxel)on HER2-positive breast cancer[J]. Anticancer Res,2017,37(10):5623-5630.
[5]王子函,滕长胜,葛智成,等.单孔法全腔镜局部扩大切除术进行保乳手术的临床应用[J].首都医科大学学报,2016,37(3):336-340.
[6] De Lorenzi F, Hubner G, Rotmensz N, et al. Oncological results of oncoplastic breast-conserving surgery:long term follow-up of a large series at a single institution:a matched-cohort analysis[J].Eur J Surg Oncol, 2016, 42(1):71-77.
[7] Rietjens M, Urban CA, Rey PC et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery[J].Breast, 2007, 16(4):387-395.
[8]陈峙霖,周恩相.保乳手术后乳腺癌患者血CD19+、自然杀伤细胞、白细胞介素-6水平变化及其对乳腺癌复发的预测价值[J].中国临床医生杂志,2017,45(1):63-65.
[9]孙萍.保乳术对乳腺癌患者血清标志物、NK细胞、CD19+细胞及术后复发的影响[J].实用临床医药杂志,2018,22(15):53-56.
[10]张干林,陈迪,张佳琦,等.乳腺癌根治术后即刻乳房再造对患者术后生存率的影响[J].中华整形外科杂志,2016, 32(4):275-279.
[11]张普生,王立坤,罗云峰,等.三维可视技术指导腔镜乳腺癌保乳并转移背阔肌瓣重建乳房[J].南方医科大学学报,2017,37(8):1131-1135.
[12]张丝媛,铁剑,于会明,等.乳腺癌保乳术后放疗瘤床二维电子线与三维调强补量的疗效比较[J].中华放射医学与防护杂志,2017,37(5):345-351.
[13]夏重升,李苗苗,范敏,等.早期乳腺癌保乳术后瘤床同步加量调强放疗的临床观察[J].中华放射医学与防护杂志,2017, 37(2):119-124.
[14]杨昭志,俞晓立,梅欣,等.早期乳腺癌保乳术后全乳IMRT及瘤床大分割同期加量的临床Ⅱ期研究[J].中华放射肿瘤学杂志,2016,25(7):703-707.
[15]钟秋子,荣庆林,唐玉,等.Ⅰ-Ⅱ期乳腺癌保乳术后放疗的临床疗效及预后分析[J].中华放射肿瘤学杂志,2018, 27(2):165-169.
[16] Valente SA, Tendulkar RD, Cherian S, et al. TARGIT-R(Retrospective):North American experience with intraoperative radiation using low-kilovoltage X-rays for breast cancer[J]. Annals of Surgical Oncology,2016, 23(9):1-7.
[17]陈旭明,郭巨江,翁一尹,等.超声引导下麦默通活检术在多发乳腺病灶中诊断早期乳腺癌的意义[J].中国普通外科杂志,2016,25(5):773-775.
[18]冯莉莉,周红悦,麻增林.动态增强扫描MR及弥散加权MRI在监测乳腺癌保乳术后肿瘤复发中的价值[J].广东医学,2017, 38(10):1561-1564.
[19]林金勇,胡彩容,张秀春,等.Tomo Direct和Tomo Helical技术在左侧乳腺癌保乳术后放疗中的剂量学比较[J].中华放射医学与防护杂志,2017,37(3):216-221.
[20] Fayanju OM, Buchholz TA, Hunt KK. Postmastectomy radiation treatment rates as a quality measure:an opportunity for compliance through collaboration[J]. Ann Surg Oncol, 2016, 23(8):2377-2379.
[21]钱钧强,张霄蓓.乳腺癌患者细胞周期蛋白依赖性激酶5调节亚基相关蛋白2表达与新辅助化疗疗效的相关性研究[J].中国全科医学,2016,19(35):4346-4349.
[22]刘和荣,周厚吾,沈文华.乳腺癌保乳+前哨淋巴结活检术的应用效果评价与技术探讨[J].广东医学,2017, 38(s1):69-71.