早期乳腺癌患者运用前哨淋巴结活检术和腋窝淋巴结清扫术的优劣差异分析
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摘要
目的:研究早期乳腺癌患者运用前哨淋巴结活检术(SLNB)和腋窝淋巴清扫(ALND)的优劣差异。方法:采用回顾性方法,分析本院从2013年3月-2015年4月收治的98例早期乳腺癌患者住院期间的病例资料以及出院后随访情况,其中采用前哨淋巴结活检术(SLNB)治疗的患者47例,采用腋窝淋巴结清扫术(ALND)治疗的患者51例,根据术式将其分为SLNB组和ALND组。对比两组患者的生活质量评分(SF-36量表评分);运用Neer肩关节功能评分及术后肩关节最大外展角比较患者术后肩关节功能;比较不同术式术后并发症发生情况。结果:术后4周,SLNB组的SF-36量表评分中总体健康、精神健康、生理功能、生理职能、社会功能及情感功能均优于ALND组(P<0.05);两组的活力和躯体疼痛评分比较,差异均无统计学意义(P>0.05)。术后1、2周,两组患者的Neer肩关节功能评分及肩关节最大外展角均低于术前(P<0.05);术后4周,两组患者的Neer肩关节功能评分与术前比较,差异均无统计学意义(P>0.05);术后1、2周,SLNB组的Neer肩关节功能评分均优于ALND组(P<0.05);术后1、2、4周,SLNB组肩关节最大外展角均大于ALND组(P<0.05)。SLNB组术后上肢疼痛、上肢麻木和活动受限发生率均低于ALND组(P<0.05),两组患者术后上肢淋巴结水肿及腋窝积液发生率比较,差异均无统计学意义(P>0.05)。结论:SLNB治疗早期乳腺癌在术后上肢功能恢复和减少并发症发生率方面均优于ALND,可明显提高患者术后生活质量,值得推广。
Objective:To study the differences between SLNB and ALND on patients with early breast cancer.Method:Using retrospective methods,98 early breast cancers who were treated in hospital from March2013 to April 2015 and followed up after discharge would be analyzing in this thesis.Of these,47 cases were treated with sentinel lymph node biopsy(SLNB)and 51 cases with axillary lymph node dissection(ALND),according to the operative method,they were divided into SLNB group and ALND group.The quality of postoperative life were assessed by health status questionnaire(SF-36);the function of postoperative shoulder joint was assessed by Neer shoulder function scores and postoperative shoulder maximum arthrodesis angles;the postoperative complications of the two groups were compared.Result:4 weeks after surgery,overall health,mental health,physiological function,physiological function,social function and emotional function in SF-36 scale score of SLNB group were all better than those of ALND group(P<0.05);there were no significant differences in vitality and physical pain scores between the two groups(P>0.05).1 and 2 weeks after surgery,Neer shoulder function score and maximum abduction angle of shoulder joint in both groups were lower than those before surgery(P<0.05);4 weeks after surgery,Neer shoulder function score of the two groups showed no significant differences from that before surgery(P>0.05).1 and 2 weeks after surgery,Neer shoulder function score of SLNB group were better than those of ALND group(P<0.05).1,2,4 weeks after surgery,the maximum abduction angle of shoulder joint in SLNB group were greater than those in ALND group(P<0.05).The incidence of postoperative upper extremity pain,numbness of upper extremity and activity limitation in SLNB group were lower than those in ALND group(P<0.05);the incidence of postoperative upper extremity lymphadendema and axillary effusion in the two groups was not statistically significant(P>0.05).Conclusion:SLNB treatment for early breast cancer is superior to ALND in postoperative recovery of upper limb function and reduction of complication rate,which can significantly improve postoperative quality of life of patients and is worthy of promotion.
Objective:To study the differences between SLNB and ALND on patients with early breast cancer.Method:Using retrospective methods,98 early breast cancers who were treated in hospital from March2013 to April 2015 and followed up after discharge would be analyzing in this thesis.Of these,47 cases were treated with sentinel lymph node biopsy(SLNB)and 51 cases with axillary lymph node dissection(ALND),according to the operative method,they were divided into SLNB group and ALND group.The quality of postoperative life were assessed by health status questionnaire(SF-36);the function of postoperative shoulder joint was assessed by Neer shoulder function scores and postoperative shoulder maximum arthrodesis angles;the postoperative complications of the two groups were compared.Result:4 weeks after surgery,overall health,mental health,physiological function,physiological function,social function and emotional function in SF-36 scale score of SLNB group were all better than those of ALND group(P<0.05);there were no significant differences in vitality and physical pain scores between the two groups(P>0.05).1 and 2 weeks after surgery,Neer shoulder function score and maximum abduction angle of shoulder joint in both groups were lower than those before surgery(P<0.05);4 weeks after surgery,Neer shoulder function score of the two groups showed no significant differences from that before surgery(P>0.05).1 and 2 weeks after surgery,Neer shoulder function score of SLNB group were better than those of ALND group(P<0.05).1,2,4 weeks after surgery,the maximum abduction angle of shoulder joint in SLNB group were greater than those in ALND group(P<0.05).The incidence of postoperative upper extremity pain,numbness of upper extremity and activity limitation in SLNB group were lower than those in ALND group(P<0.05);the incidence of postoperative upper extremity lymphadendema and axillary effusion in the two groups was not statistically significant(P>0.05).Conclusion:SLNB treatment for early breast cancer is superior to ALND in postoperative recovery of upper limb function and reduction of complication rate,which can significantly improve postoperative quality of life of patients and is worthy of promotion.
引文
[1]梅俊,易茂林.乳腺癌腋窝淋巴结清除术的临床效果[J].中国肿瘤临床与康复,2015,22(7):796-798.
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[11]崔嵘嵘,林晓燕,许诚,等.染料示踪剂联合荧光示踪法提高乳腺癌前哨淋巴结活检术成功率[J].中国全科医学,2016,19(24):2900-2903.
[12]雷海,黄晓蓉,闫珊玲,等.荧光联合染料染色在乳腺癌前哨淋巴结活检中的应用研究[J].中国综合临床,2015,31(12):1067.
[13]何友新,才忠启.乳腺癌前哨淋巴结活检138例临床分析[J].中国基层药,2016,23(16):2405.
[14]王梅,汤鹏,袁素,等.早期乳腺癌施行单纯乳房切除加前哨淋巴结活检术临床疗效对比研究[J].中国妇幼保健,2015,30(29):4949-4951.
[15]左文述,杨奔,戴萦企,等.前哨淋巴结活检对乳腺癌区域外科治疗理念的影响[J].中华内分泌外科杂志,2015,3(2):89-92.
[16]Owaki T,Kijima Y,Yoshinaka H,et al.Present status of endoscopic mastectomy for breast cancer[J].World J Clin Oncol,2015,6(3):25-29.
[17]Ding B,Qian L,Zhao Y,et al.Meta-analysis of endoscopic axillary lymph node dissection versus conventional open excision for breast cancer[J].Zhong Nan Da Xue Bao Yi Xue Ban,2015,40(7):782-789.
[2]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范[J].中国癌症杂志,2015,25(9):692-754.
[3]Pouw J J,Bastiaan D M,Klaase J M,et al.Phantom study quantifying the depth performance of a handheld magnetometer for sentinel lymph node biopsy[J].Phys Med,2016,32(7):926-931.
[4]黄林平,刘军.荧光法前哨淋巴结活检在早期乳腺癌中的应用(附文献复习)[J].中日友好医院学报,2013,27(4):195-199.
[5]黄国兴,苏国森,李上芹,等.前哨淋巴结活检术替代传统腋窝淋巴结清扫术对早期乳腺癌患者术后免疫功能及预后的影响[J/OL].中华临床医师杂志(电子版),2016,10(7):947-949.
[6]刘旋.保乳联合前哨淋巴结活检手术对老年性乳腺癌的治疗效果分析[J].当代医学,2016,22(21):66-67.
[7]王子函,滕长胜,葛智成,等.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[J].临床和实验医学杂志,2015,14(15):1297-1300.
[8]单风晓,任铁军.早期姑息治疗在晚期转移性乳腺癌初治中的临床意义[J].中国临床新医学,2016,9(5):409-412.
[9]王永胜,邱鹏飞.乳腺癌前哨淋巴结活检术新型荧光靶向示踪剂的研发进展[J].医学与哲学,2016,37(18):14-16.
[10]刘现义,李中,王晓春.前哨淋巴结活检术在早期乳腺癌保乳术中的应用[J].陕西医学杂志,2016,45(6):682-683.
[11]崔嵘嵘,林晓燕,许诚,等.染料示踪剂联合荧光示踪法提高乳腺癌前哨淋巴结活检术成功率[J].中国全科医学,2016,19(24):2900-2903.
[12]雷海,黄晓蓉,闫珊玲,等.荧光联合染料染色在乳腺癌前哨淋巴结活检中的应用研究[J].中国综合临床,2015,31(12):1067.
[13]何友新,才忠启.乳腺癌前哨淋巴结活检138例临床分析[J].中国基层药,2016,23(16):2405.
[14]王梅,汤鹏,袁素,等.早期乳腺癌施行单纯乳房切除加前哨淋巴结活检术临床疗效对比研究[J].中国妇幼保健,2015,30(29):4949-4951.
[15]左文述,杨奔,戴萦企,等.前哨淋巴结活检对乳腺癌区域外科治疗理念的影响[J].中华内分泌外科杂志,2015,3(2):89-92.
[16]Owaki T,Kijima Y,Yoshinaka H,et al.Present status of endoscopic mastectomy for breast cancer[J].World J Clin Oncol,2015,6(3):25-29.
[17]Ding B,Qian L,Zhao Y,et al.Meta-analysis of endoscopic axillary lymph node dissection versus conventional open excision for breast cancer[J].Zhong Nan Da Xue Bao Yi Xue Ban,2015,40(7):782-789.