乳腔镜辅助腋窝淋巴结清扫手术对乳腺癌患者上肢功能及生活质量的影响
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摘要
目的探讨乳腔镜辅助腋窝淋巴结清扫手术对乳腺癌患者上肢功能及生活质量的影响,为治疗乳腺癌提供参考。方法选取2010年6月—2013年6月肿瘤外科就诊的早期乳腺癌患者172例为研究对象,根据入院时间分为乳腔镜下腋窝淋巴结清扫术组和常规腋窝淋巴结清扫术组各86例,比较2组手术指标、上肢功能、生活质量。结果观察组术中出血量、腋窝引流量明显低于对照组[(65.42±7.37)ml vs.(185.53±22.86)ml,(114.25±35.06)ml vs.(188.79±48.13)ml],t=46.375、11.609,P<0.05;随访6个月,观察组肩关节前屈、后伸、内收、外展、内旋、外旋等角度均明显高于对照组(t=27.689、5.339、4.176、16.805、9.269、9.395,均P<0.05),观察组患者术后患肢感觉异常等并发症发生率(10.47%)明显低于对照组(40.70%,χ2=20.645,P<0.05),认知功能、躯体功能、社会角色功能、情绪功能等生活质量评分均明显高于对照组(t=25.998、7.213、6.439、5.551,均P<0.05)。结论乳腔镜辅助腋窝淋巴结清扫术有助于减轻手术创伤,促进上肢功能恢复,提高生活质量。
Objective To investigate the effect of mastoscopy assisted axillary lymph node dissection( ALND) surgery on upper limb function and quality of life of patients with breast cancer,and provide reference for treatment of breast cancer.Methods Total 172 cases early breast cancer in our department between June,2010 and June,2013 were enrolled and assigned into mastoscopic axillary lymph node dissection group( observational group) and conventional axillary lymph node dissection group( control group) with 86 cases in each group. The operation indicators,upper limb function and the quality of life were compared between the two groups. Results The amount of intraoperative bleeding and volume of axillary drainage in the observational group was significantly lower than that of the control group[( 65. 42 ± 7. 37 vs. 185. 53 ±22. 86) ml,( 114. 25 ± 35. 06 vs. 188. 79 ± 48. 13) ml,respectively],t = 46. 375,11. 609,P < 0. 05; The 6-month follow-up showed that the angle of shoulder flexion,extension,adduction,abduction,pronation,and external rotation in the observational group were significantly greater than those in the control group( t = 7. 689,5. 339,4. 176,16. 805,9. 269 and 9. 395,P < 0. 05); The incidence of complications such as limb paresthesia was 10. 47% in the observational group,which was significantly lower than 40. 70% in the control group( χ2= 20. 645,P < 0. 05). The scores of cognitive function,physical function and other quality of life in the observational group were significantly higher than those in the control group( t = 5. 998,7. 213,6. 439,5. 551,P < 0. 05). Conclusion Mastoscopy assisted axillary lymph node dissection is helpful to reduce the trauma,promote the recovery of upper limb function,improve the quality of life.
Objective To investigate the effect of mastoscopy assisted axillary lymph node dissection( ALND) surgery on upper limb function and quality of life of patients with breast cancer,and provide reference for treatment of breast cancer.Methods Total 172 cases early breast cancer in our department between June,2010 and June,2013 were enrolled and assigned into mastoscopic axillary lymph node dissection group( observational group) and conventional axillary lymph node dissection group( control group) with 86 cases in each group. The operation indicators,upper limb function and the quality of life were compared between the two groups. Results The amount of intraoperative bleeding and volume of axillary drainage in the observational group was significantly lower than that of the control group[( 65. 42 ± 7. 37 vs. 185. 53 ±22. 86) ml,( 114. 25 ± 35. 06 vs. 188. 79 ± 48. 13) ml,respectively],t = 46. 375,11. 609,P < 0. 05; The 6-month follow-up showed that the angle of shoulder flexion,extension,adduction,abduction,pronation,and external rotation in the observational group were significantly greater than those in the control group( t = 7. 689,5. 339,4. 176,16. 805,9. 269 and 9. 395,P < 0. 05); The incidence of complications such as limb paresthesia was 10. 47% in the observational group,which was significantly lower than 40. 70% in the control group( χ2= 20. 645,P < 0. 05). The scores of cognitive function,physical function and other quality of life in the observational group were significantly higher than those in the control group( t = 5. 998,7. 213,6. 439,5. 551,P < 0. 05). Conclusion Mastoscopy assisted axillary lymph node dissection is helpful to reduce the trauma,promote the recovery of upper limb function,improve the quality of life.
引文
[1]王妍,原晓燕,张春侠,等.乳腔镜腋窝淋巴结清扫术与常规淋巴结清扫术治疗乳腺癌的临床效果[J].现代生物医学进展,2016,16(20):3887-3889.
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[9]李同义,于志勇,门秀东,等.基于脂肪溶解抽吸的腔镜腋窝淋巴结清扫术治疗乳腺癌疗效观察[J].山东医药,2013,53(13):79-80.
[10]Chereau E,Uzan C,Boutmy-Deslandes E,et al.Evaluation of the Effects of Pasireotide LAR Administration on Lymphocele Prevention after Axillary Node Dissection for Breast Cancer:Results of a Randomized NonComparative Phase 2 Study[J].Plo S One,2016,11(6):e0156096.
[11]张前进,胡伯年,裴俊烽.乳腔镜前哨淋巴结活检及腋窝淋巴结清扫的临床应用分析[J].中华全科医学,2015,13(4):574-575,578.
[12]单远洲,张明,朱光辉,等.腔镜下腋窝淋巴结清扫与传统手术的对比研究[J].南昌大学学报(医学版),2013,53(10):18-20,23.
[13]Esposito E,Sollazzo V,Di Micco R,et al.Can axillary node dissection be safely omitted in the elderly?A retrospective study on axillary management of early breast cancer in older women[J].Int J Surg,2016,33:S114-S118.
[14]程越,林方才,孙欣.乳腺癌相关上肢淋巴水肿诊疗现状[J].中国微创外科杂志,2016,16(4):370-376.
[15]蔡凤林,邵稳喜,章佳新,等.保乳联合前哨淋巴结活检术治疗老年乳腺癌42例临床分析[J].中华普通外科学文献(电子版),2016,10(1):71-73.
[2]Luo C,Guo W,Yang J,et al.Comparison of mastoscopic and conventional axillary lymph node dissection in breast cancer:long-term results from a randomized,multicenter trial[J].Mayo Clin Proc,2012,87(12):1153-1161.
[3]张前进,胡伯年,裴俊烽.乳腔镜前哨淋巴结活检及腋窝淋巴结清扫的临床应用分析[J].中华全科医学,2015,13(4):574-575,578.
[4]Huang TW,Kuo KN,Chen C,et al.Recommendation for axillary lymph node dissection in women with early breast cancer and sentinel node metastasis:A systematic review and meta-analysis of randomized controlled trials using the GRADE system[J].Int J Surg,2016,34:73-80.
[5]Bergquist H,Johnsson E,Nyman J,et al.Combined stent inser-tion and single high-dose brachytherapy in patients with advanced esophageal cancer-results of a prospective safety study[J].Dis Esophagus,2012,25(5):410-415.
[6]罗云峰,张普生,邓鉴文.腔镜乳腺癌改良根治术保留肋间臂神经的临床观察[J].中国普通外科杂志,2012,21(11):1334-1337.
[7]Cook KH,Park MC,Lee IJ,et al.Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection[J].J Breast Cancer,2016,19(1):92-95.
[8]张月,王耀一,孙光源,等.腔镜下前哨淋巴结活栓及腋窝淋巴清扫在早期乳腺癌手术中的应用[J].实用癌症杂志,2015,30(9):1335-1338.
[9]李同义,于志勇,门秀东,等.基于脂肪溶解抽吸的腔镜腋窝淋巴结清扫术治疗乳腺癌疗效观察[J].山东医药,2013,53(13):79-80.
[10]Chereau E,Uzan C,Boutmy-Deslandes E,et al.Evaluation of the Effects of Pasireotide LAR Administration on Lymphocele Prevention after Axillary Node Dissection for Breast Cancer:Results of a Randomized NonComparative Phase 2 Study[J].Plo S One,2016,11(6):e0156096.
[11]张前进,胡伯年,裴俊烽.乳腔镜前哨淋巴结活检及腋窝淋巴结清扫的临床应用分析[J].中华全科医学,2015,13(4):574-575,578.
[12]单远洲,张明,朱光辉,等.腔镜下腋窝淋巴结清扫与传统手术的对比研究[J].南昌大学学报(医学版),2013,53(10):18-20,23.
[13]Esposito E,Sollazzo V,Di Micco R,et al.Can axillary node dissection be safely omitted in the elderly?A retrospective study on axillary management of early breast cancer in older women[J].Int J Surg,2016,33:S114-S118.
[14]程越,林方才,孙欣.乳腺癌相关上肢淋巴水肿诊疗现状[J].中国微创外科杂志,2016,16(4):370-376.
[15]蔡凤林,邵稳喜,章佳新,等.保乳联合前哨淋巴结活检术治疗老年乳腺癌42例临床分析[J].中华普通外科学文献(电子版),2016,10(1):71-73.