新辅助化疗对腔镜乳腺癌改良根治术后并发症及疗效的影响  

Impact of neoadjuvant chemotherapy on postoperative complications and efficacy after endoscopic modified mastectomy in breast cancer patients

作　　者：梁全琨 张永松[1] 钟玲[1] 范林军[1] 

机构地区：[1]第三军医大学西南医院乳腺外科,重庆400038

出　　处：《中华乳腺病杂志（电子版）》2015年第1期16-20,共5页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：西南医院临床创新基金资助项目(SWH2013LC09)

摘　　要：目的评估新辅助化疗对腔镜乳腺癌改良根治术患者术后并发症及疗效的影响。方法回顾性分析2007年1月至2010年12月本科收治的183例乳腺癌腔镜手术患者的临床资料，其中98例先接受新辅助化疗再行腔镜乳腺癌改良根治术（NCT组），85例直接行腔镜乳腺癌改良根治术（对照组）。比较两组之间手术情况[手术时间、出血量、引流量、前哨淋巴结活组织检查（简称活检）率及淋巴结转移率]，术后并发症（感染、乳头或皮瓣坏死及上肢水肿发生率），以及远期疗效（局部复发率、远处转移率及病死率）的差异，其中，定量资料的比较采用t检验，定性资料的比较采用，检验或Fisher确切概率检验。并根据患者随访时间和死亡情况制作累积病死率曲线图。结果NCT组与对照组间手术时间、出血量、引流量、前哨淋巴结活检率及淋巴结转移方面的差异均无统计学意义（t=-0．381、1．468、-0．725,X^2=1．137、1．022；P=0．704、0．144、0．469、0．286、0．312）。两组患者术后感染（P=0．475）、乳头或皮瓣坏死及上肢水肿发生率（X^2=0．005、1．117，P=0．946、0．291）的差异均无统计学意义。中位随访51个月（9～77个月），两组患者的局部复发率（P=1．000）、远处转移率及病死率（r=0．123、0．009，P=0．726、0．925）差异也均无统计学意义。结论新辅助化疗不增加腔镜乳腺癌改良根治术后并发症的发生率，不做新辅助化疗也不影响腔镜乳腺癌改良根治术后的远期疗效。Objective To evaluate the impact of neoadjuvant chemotherapy （NCT） on postoperative complications and efficacy after endoscopic masteetomy in breast cancer patients. Methods We retrospectively reviewed the clinical data of 183 breast cancer patients who underwent endoscopic modified mastectomy in our department from January 2007 to December 2010 ,in which 98 received NCT before surgery （NCT group） and 85 received endoscopic modified masteetomy directly （control group ）. The operation data （operation time, amount of bleeding, amount of drainage, rate of sentinel lymph node biopsy and lymph node metastasis ）, postoperative complications （infection, necrosis of nipple or skin flap and edema of upper extremities）and long- term efficacy （local recurrence,rate of distant metastasis and mortality） were compared between two groups. t test was used for measurement data, X^2 test and Fisher＇ s exact probability test for count data. Then based on the follow-up time and deaths, the cumulative mortality curves were drawn. Results There were no significant differences in operation time, amount of bleeding, amount of drainage, rate of sentinel lymph node biopsy and lymph node metastasis between two groups（ t = -0. 381,1. 468, -0. 725, X^2 = 1. 137,1. 022 ;P = 0.704,0. 144, 0.469,0. 286,0. 312）. The rates of postoperative infection（ P = 0. 475 ）, necrosis of nipple or skin flap and edema of upper extremities （ X^2 = 0. 005,1.117 ; P = 0. 946 , 0. 291 ） showed no significantly statistical difference. Median follow-up time was 51 months （9- 77 months ）. The follow-up showed no significantly statistical difference between two groups in local recurrence （ P = 1. 000 ）, distant metastasis rate and mortality （ X^2 = 0. 123,0.009;P=0.726,0.925）. Conclusion In breast cancer patients,NCT can not increase postoperative complications of endoscopic modified mastectomy, but the long-term efficacy will not be influenced by NCT.

关 键 词：化学疗法 辅助 内窥镜 乳腺肿瘤 手术后并发症 治疗结果 

分 类 号：R737.9[医药卫生—肿瘤]