Effect of breast conservative surgery combined with sentinel lymph node biopsy on the armpit extubation time, shoulder range of motion and long-term outcomes of patients with early breast cancer
WANG Chunshu1 LI Xin1 WEN Jian1▲ LI Pingping2
1.Department of Anesthesiology, the First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi Province, Xi’an 710061, China;
2.Medical Transformation Center, the First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi Province, Xi’an 710061, China
Abstract：Objective To explore the effect of breast conservative surgery combined with sentinel lymph node biopsy on the armpit extubation time, shoulder range of motion and long-term outcomes of patients with early breast cancer. Methods The medical records of 92 cases of early breast cancer treated in the First Affiliated Hospital of Xi’an Jiaotong University from October 2015 to October 2017 were studied. Of which 44 cases received breast conservative surgery combined with sentinel lymph node biopsy (observation group) and 48 cases received modified radical mastectomy (control group). Perioperative parameters (length of operation, amount of bleeding during operation, total volume of drainage, armpit extubation time, length of stay), shoulder range of motion (outward-rotating, inward-rotating, backward extension, outreaching, bending) before and after surgery, postoperative complications, satisfaction with the result of breast cosmetology, scores of the specific questionnaire to patients with breast cancer after surgery (QLQ-BR23), and results of the follow-up survey of patients in two groups were compared. Results The operation time of observation group was longer than that of control group, the intraoperative blood loss and total drainage volume of observation group were less than those of control group, the axillary extubation time and hospitalization time of observation group were shorter than those of control group, the differences were statistically significant (P < 0.05). Six months after operation, the external rotation, internal rotation, extension, abduction and flexion of shoulder joint in two groups were decreased compared with those before operation (P < 0.05), but observation group was larger than that of control group (P < 0.05). The incidence of complication in observation group was lower than that in control group (P < 0.05). The satisfaction of breast beauty in observation group was higher than that in control group six months after operation (P < 0.05). The reliability and validity of the self-made questionnaire of breast beauty satisfaction: Cronbach’s α coefficient was 0.854, test-retest reliability was 0.836. The content validity index was 0.817. The scores of body image, sexual function, sexual pleasure and future view in observation group were higher than those in control group six months after operation, while the scores of breast symptoms and upper limb symptoms in observation group were lower than those in control group (P < 0.05). There were no significant differences in the scores of hair loss and side effects between two groups (P > 0.05). Followed up for one year, there were no significant differences in survival rate, recurrence rate and metastasis rate between two groups (P > 0.05). Conclusion The treatment of breast conservative surgery combined with sentinel lymph node biopsy can produce a therapeutic effect close to that of modified radical mastectomy in patients with early breast cancer, while having such advantages as faster recovery after operation and smaller impact on the appearance and activities of daily living of the breasts.
王春姝1 李欣1 温健1▲ 李萍萍2. 保乳手术联合前哨淋巴结活检术对早期乳腺癌患者腋窝拔管时间、肩关节活动度及远期疗效的影响[J]. 中国医药导报, 2020, 17(36): 105-109.
WANG Chunshu1 LI Xin1 WEN Jian1▲ LI Pingping2. Effect of breast conservative surgery combined with sentinel lymph node biopsy on the armpit extubation time, shoulder range of motion and long-term outcomes of patients with early breast cancer. 中国医药导报, 2020, 17(36): 105-109.
[1] 赵长啸，董力.保乳手术与改良根治术治疗早期乳腺癌临床疗效的比较[J].中国肿瘤临床与康复，2016，12（11）：1316-1318.
[2] Siegel RL，Miller KD，Jemal A. Cancer statistics [J]. CA Cancer J Clin，2017，67（1）：7-30.
[3] 傅家清，闫金亮，田景中，等.保乳联合前哨淋巴结活检手术对老年乳腺癌患者术后恢复状况及并发症的影响[J].中华全科医学，2016，14（3）：407-408，490.
[4] 孙荣能，赵迎，陈剑平.保乳联合前哨淋巴结活检术对早期乳腺癌患者生活质量的影响[J].中国地方病防治杂志，2017，32（2）：105-106.
[5] 王梅芳，李小妹.乳腺癌化疗患者癌性疲乏、应对方式与生活质量的相关性[J].中国心理卫生杂志，2009，13（5）：776-779.
[6] Sugie T. Sentinel lymph node biopsy using indocyanine green fluorescence in early-stage breast cancer：a meta-analysis [J]. Int J Clin Oncol，2017，22（1）：11-17．
[7] 唐政，王继伟，张庆云，等.QLQBR23和EoRTC QLQ-C30测量康复锻炼对乳腺癌患者生命质量的影响[J].复旦学报：医学版，2015，42（5）：589-595.
[8] 郑希希，贾勇圣，史业辉，等.乳腺癌多原发癌的临床病理特征及预后分析[J].中国肿瘤临床，2017，44（5）：219-223.
[9] 袁琳，姚燕，郑艳，等.乳腺癌保乳手术和改良根治术对女性婚姻质量影响对比[J].中国性科学，2017，26（10）：66-68.
[10] 艾克热木，艾沙，阿布拉，等.早期乳腺癌保乳手术与改良根治术的临床疗效及生活质量比较[J].中国普通外科杂志，2016，23（11）：109-110.
[11] 单世胜，葛冠群，王华龙.前哨淋巴结活检在早期浸润性乳腺癌保乳手术中的应用价值[J].中国妇幼保健，2018，33（7）：1453-1456.
[12] 高静，陈娟，王丹，等.术前访视应用循证护理在乳腺癌患者围手术期中的应用[J].现代医药卫生，2018，34（5）：761-763.
[13] 张珊，曾繁余，唐巍，等.保乳联合前哨淋巴结活检对老年乳腺癌患者的疗效及对术后生活质量及美容效果的影响[J].实用癌症杂志，2016，31（1）：128-131.
[14] 李立新，符国宏.保乳术联合前哨淋巴结活检在老年乳腺癌患者术后的效果[J].基因组学与应用生物学，2018， 37（11）：219-224.
[15] 陈宏亮.前哨淋巴结阳性的乳腺癌患者非前哨淋巴结转移影响因素分析[J].复旦学报：医学版，2015，42（4）：460-464．
[16] 高峰清，张海宏，冯秀梅.保乳术联合前哨淋巴结活检与传统乳腺根治术对乳腺癌患者临床疗效及应激指标观察[J].川北医学院学报，2019，34（1）：99-102.
[17] Han C. The feasibility and oncological safety of axillary reverse mapping in patients with breast cancer：a systematic review and meta-analysis of prospective studies [J]. PLoS One，2016，11（2）：113-117．
[18] 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（1）：69-73.
[19] 王永亮，柴辉，万东民，等.保乳术联合前哨淋巴结活检治疗乳腺癌30例临床疗效分析[J].山西医药杂志，2019， 48（15）：88-90.
[20] 张燕，李三荣，肖敏.保乳及前哨淋巴结活检术在老年乳腺癌患者中的临床疗效及安全性[J].实用临床医药杂志，2018，22（3）：59-62.
[21] 王宏，曹旭晨，杨绍时，等.保乳联合前哨淋巴结活检术治疗早期乳腺癌患者80例临床观察[J].山东医药，2015， 55（45）：54-56.
[22] Folli S. Repeat sentinel lymph node biopsy in patients with ipsilateral recurrent breast cancer after breast conserving therapy and negative sentinel lymph node biopsy：a prospective study [J]. Minerva Chir，2016，17（2）：73-79．
[23] 陈蔓青，吴春山，黄秀珠.保乳术联合前哨淋巴结活检术与改良根治术治疗早期三阴性乳腺癌的效果比较[J].中国民康医学，2019，31（7）：9-11.
[24] 贺新伟，王学中.前哨淋巴结活检与腋窝淋巴结清扫术在早期乳腺癌患者的应用对比[J].中国全科医学，2017， 20（S1）：63-65.
[25] Lane WO，Thomas SM，Blitzblau RC，et al. Surgical resection of the primary tumor in women with de novo stage Ⅳ breast cancer：contemporary practice patterns and survival analysis [J]. Ann Surg，2017，269（3）：537-544.
[26] 曹余彦.新辅助化疗后保乳手术治疗乳腺癌的临床效果[J].中国医药科学，2019，9（2）：207-210.
[27] 王志超.早期乳腺癌患者行前哨淋巴结活检术保留腋窝功能的临床应用价值[J].中国现代医生，2020，58（8）：45-47.
[28] 杨丽君，朱玉兰.前哨淋巴结活检在早期浸润性乳腺癌治疗中的应用疗效评价[J].当代医学，2019，25（34）：161-162.
2020, Vol. 17 
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