不同手术入路对乳腺癌改良根治术后肿瘤控制效果及安全性的影响研究

许涛; 章锐

doi:10.13898/j.cnki.issn.1000-2200.2021.03.011

不同手术入路对乳腺癌改良根治术后肿瘤控制效果及安全性的影响研究

许涛,
章锐

Effect of different surgical approaches on tumor control and safety after modified radical mastectomy for breast cancer

XU Tao,
ZHANG Rui

摘要

摘要:
目的分析不同手术入路对乳腺癌改良根治术后肿瘤控制效果及安全性的影响。
方法选择106例拟行乳腺癌改良根治术的乳腺癌病人作为研究对象，随机分为A组和B组，各53例；A组采用经胸大肌前方入路，B组采用经胸大肌后方入路。比较2组围术期指标（手术时间、引流时间、住院时间、术中出血量、总引流量、淋巴结清扫时间）、并发症发生情况、生存质量，随访5~29个月，观察局部复发、远处转移和生存情况。
结果2组病人均顺利完成手术，A组手术时间、术中出血量、淋巴结清扫时间、引流时间、总引流量、住院时间均明显低于B组（P < 0.01）。2组皮下积液、皮瓣坏死、上肢水肿发生率差异均无统计学意义（P>0.05）；A组胸大肌重度萎缩发生率、腋窝和上臂内侧感觉障碍发生率均明显低于B组（P < 0.01）。A组术后8周生存质量量表中躯体、心理、社会支持和精神评分均明显高于B组（P < 0.01）。所有病人均获得随访，平均随访（19.47±4.56）个月。2组腋窝淋巴结复发率、锁骨上淋巴结转移率、远处转移率和总生存率差异均无统计学意义（P>0.05）。
结论经胸大肌前方入路行乳腺癌改良根治术较经胸大肌后方入路可有效减轻术中创伤，减少术后并发症发生，提高生存质量，且肿瘤控制效果未受明显影响，值得进一步研究应用。

Abstract:
ObjectiveTo analyze the effects of different surgical approaches on tumor control and safety after modified radical mastectomy.
MethodsA total of 106 breast cancer patients scheduled by modified radical mastectomy for breast cancer were randomly divided into the group A and group B(53 cases in each group).The group A was treated with anterior ectopectoralis approach, and the group B was treated with posterior ectopectoralis approach.The perioperative indicators(including operation time, drainage time, hospital stay, intraoperative blood loss, total drainage volume and lymph node dissection time), complications and quality of life were compared between two groups.Two groups were followed up for 5 to 29 months, and the local recurrence, distant transfer and survival in two groups were observed.
ResultsThe operative time, intraoperative blood loss, lymph node dissection time, drainage time, total drainage volume and length of hospital stay in group A were significantly lower than those in group B(P < 0.01).There was no statistical significance in the incidence rates of subcutaneous effusion, skin flap necrosis and upper limb edema between two groups(P>0.05).The incidence rates of severe pectoralis major atrophy and sensory disturbance in axilla and upper medial arm in group A were significantly lower than those in group B(P < 0.01).The scores of physical, psychological, social support and spiritual quality of life in group A after 8 weeks of operation were significantly higher than those in group B(P < 0.01).All patients were followed up for (19.47±4.56) months.There was no statistical significance in the rates of axillary lymph node recurrence, suclavicular lymph node metastasis, distant lymph node metastasis and overall survival between two groups(P>0.05).
ConclusionsModified radical mastectomy through the anterior ectopectoralis approach can reduce the intraoperative trauma and postoperative complications and improve the quality of life, and its effects on the tumor control is not significant, which is worthy of further study and application.

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