乳腔镜辅助下行保乳手术治疗乳腺癌预防复发的效果及对患者免疫功能的影响
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摘要
目的分析乳腔镜辅助下行保乳手术治疗乳腺癌预防复发的效果及对患者免疫功能的影响。方法选取我院2014年1月-2016年7月收治的乳腺癌患者98例,根据手术方法不同分为对照组和观察组。对照组患者采用传统保乳手术,观察组患者采用乳腔镜辅助下行保乳手术,分析两组患者治疗后的临床效果。结果观察组患者术中出血量、引流量均少于对照组,住院时间短于对照组,但淋巴结清扫数目与对照组比较,差异无统计学意义(P>0.05)。术前,两组患者免疫功能指标、PGE2、PCT、TNF-α水平比较,差异均无统计学意义(P> 0.05)。术后3 d,观察组患者PGE2、PCT、TNF-α水平均低于对照组,免疫功能指标优于对照组,差异有统计学意义(P<0.05)。术前,两组患者血清肿瘤标志物、VEGF-A、VEGFR-1水平比较,差异均无统计学意义(P>0.05)。术后,观察组患者血清肿瘤标志物、VEGF-A、VEGFR-1水平与对照组比较,差异均无统计学意义(P>0.05)。两组患者复发率比较,差异无统计学意义(χ~2=1.043,P=0.307)。结论乳腔镜辅助下行保乳手术治疗乳腺癌手术创伤小,对机体应激因子、免疫功能影响较小,抑制血清肿瘤标志物、VEGF-A表达效果与传统保乳手术相当。
Objective To analyze the effect of breast conserving surgery assisted by breast endoscopy on the prevention of recurrence of breast cancer and its influence on the immune function of patients. Methods Ninety-eight patients with breast cancer admitted to our hospital between January 2014 and July 2016 were divided into the control group and observation group according to surgical methods. The patients in the control group underwent the conventional breast conserving operations,while those in the observation group were treated with breast endoscopy-assisted breast conserving surgery. The clinical effects of the two groups were compared. Results The amount of bleeding in the observation group was smaller than that of the control group and the length of hospital stay was shorter,but the number of lymph nodes dissected was not significantly different( P>0.05). There was no significant difference between the two groups in immune function indexes,PGE2,PCT or TNF-alpha levels before operation( P>0.05). Three days after operation,the levels of PGE2,PCT and TNF-alpha in the observation group were lower than those in the control group,but the immune function indexes were better. The difference was statistically significant( P<0.05). The difference in serum tumor markers,VEGF-A and VEGFR was statistically significant between the two groups before operation. The case was the same after operation. There was no significant difference in the recurrence rate between the two groups( χ~2= 1.043,P = 0.307).Conclusion Breast conserving surgery assisted by breast endoscopy results in less trauma and has little effect on the body's stress factors and immune function. This approach can inhibit the expression of serum tumor marker( VEGF-A) almost as effectively as traditional breast conserving surgery.
Objective To analyze the effect of breast conserving surgery assisted by breast endoscopy on the prevention of recurrence of breast cancer and its influence on the immune function of patients. Methods Ninety-eight patients with breast cancer admitted to our hospital between January 2014 and July 2016 were divided into the control group and observation group according to surgical methods. The patients in the control group underwent the conventional breast conserving operations,while those in the observation group were treated with breast endoscopy-assisted breast conserving surgery. The clinical effects of the two groups were compared. Results The amount of bleeding in the observation group was smaller than that of the control group and the length of hospital stay was shorter,but the number of lymph nodes dissected was not significantly different( P>0.05). There was no significant difference between the two groups in immune function indexes,PGE2,PCT or TNF-alpha levels before operation( P>0.05). Three days after operation,the levels of PGE2,PCT and TNF-alpha in the observation group were lower than those in the control group,but the immune function indexes were better. The difference was statistically significant( P<0.05). The difference in serum tumor markers,VEGF-A and VEGFR was statistically significant between the two groups before operation. The case was the same after operation. There was no significant difference in the recurrence rate between the two groups( χ~2= 1.043,P = 0.307).Conclusion Breast conserving surgery assisted by breast endoscopy results in less trauma and has little effect on the body's stress factors and immune function. This approach can inhibit the expression of serum tumor marker( VEGF-A) almost as effectively as traditional breast conserving surgery.
引文
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[7]潘音桦,邹全庆,周燕秋.乳腔镜辅助下腋窝淋巴清扫对乳腺癌患者炎性应激及免疫应激的影响[J].实用临床医药杂志,2017,21(13):61.
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[9]李景涛.术后放疗对局部淋巴结阳性行保乳手术的乳腺癌患者临床预后的影响[J].实用癌症杂志,2017,32(12):2052.
[10]BODLA A S,SALEHI-BIRD S,KIRBY R,et al.Effect of formalin fixation on volume of breast conserving surgery specimens[J]. Eur J Surg Oncol,2018,44(6):879.
[11]卜智斌,曹强,王勇,等.新辅助化疗后保乳手术治疗三阴性乳腺癌的临床疗效分析[J].现代生物医学进展,2016,16(30):5930.
[12]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.
[13]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.
[14]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.
[15]刘宝胤,骆成玉,陈忠存.乳腔镜辅助乳腺癌保乳手术后自体脂肪颗粒注射成形术近期疗效[J].北京医学,2016,38(10):1044.
[2]KOH H K,SHIN K H,KIM K,et al.Effect of time interval between breast-conserving surgery and radiation therapy on outcomes of node-positive breast cancer patients treated with adjuvant doxorubicin/cyclophosphamide followed by taxane[J].Cancer Res Treat,2016,48(2):483.
[3]程海江,张莹.Orem自理模式对乳腺癌腔镜保乳术后患者精神状态及生活质量的影响[J].河北医药,2016,38(16):2553.
[4]LAI H W,CHEN S T,CHEN D R,et al.Current trends in and indications for endoscopy-assisted breast surgery for breast cancer:results from a six-year study conducted by the taiwan endoscopic breast surgery cooperative group[J].PLOS One,2016,11(3):e0150310.
[5]陈宏亮,王懋莉,张征,等.乳腺癌真空辅助旋切术后保乳手术的可行性[J].中国临床医学,2016,23(6):710.
[6]聂斌,李平,曾勇,等.保乳术治疗乳腺癌的中远期疗效及术后复发相关因素分析[J].山西医药杂志,2017,46(16):1939.
[7]潘音桦,邹全庆,周燕秋.乳腔镜辅助下腋窝淋巴清扫对乳腺癌患者炎性应激及免疫应激的影响[J].实用临床医药杂志,2017,21(13):61.
[8]ODAGIRI H,IIZUKA T,KIKUCHI D,et al.Gastrointestinal endoscopy-assisted minimally invasive surgery for superficial cancer of the uvula[J]. Clin Endosc,2016,49(3):289.
[9]李景涛.术后放疗对局部淋巴结阳性行保乳手术的乳腺癌患者临床预后的影响[J].实用癌症杂志,2017,32(12):2052.
[10]BODLA A S,SALEHI-BIRD S,KIRBY R,et al.Effect of formalin fixation on volume of breast conserving surgery specimens[J]. Eur J Surg Oncol,2018,44(6):879.
[11]卜智斌,曹强,王勇,等.新辅助化疗后保乳手术治疗三阴性乳腺癌的临床疗效分析[J].现代生物医学进展,2016,16(30):5930.
[12]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.
[13]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.
[14]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.
[15]刘宝胤,骆成玉,陈忠存.乳腔镜辅助乳腺癌保乳手术后自体脂肪颗粒注射成形术近期疗效[J].北京医学,2016,38(10):1044.