前哨淋巴结活检对早期乳腺癌患者术后免疫功能及预后的影响  

Influences of Sentinel Lymph Node Biopsy Following Total Mastectomy on Immunologic Function and Prognosis for Patients with Early Breast Cancer

作　　者：徐旭东 卢建芹[2] 沈汉斌 罗智勇[3] 夏耘[3] 张林[3] 吴亚群[3] 

机构地区：[1]武汉市第五医院甲乳外科,湖北武汉430050 [2]华中科技大学同济医学院附属同济医院肿瘤科,湖北武汉430030 [3]华中科技大学同济医学院附属同济医院甲乳外科,湖北武汉430030

出　　处：《中国普外基础与临床杂志》2015年第5期610-614,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨乳房全切除加前哨淋巴结活检对早期乳腺癌患者术后免疫功能及预后的影响。方法211例前哨淋巴结活检阴性的早期乳腺癌患者被随机分为对照组和研究组,其中对照组86例,全部行乳房全切除加前哨淋巴结活检加腋窝淋巴结清扫术;研究组125例,全部行乳房全切除加前哨淋巴结活检。分析2组患者术后1年肩关节功能情况,并比较2组患者术前1 d、术后2周、术后4周T淋巴细胞亚群和IL-2水平的变化,同时分析患者术后5年死亡率和复发率。结果 1研究组术后Neer肩关节功能评分为(93.5±8.2)分,明显高于对照组的(72.7±6.5)分,差异有统计学意义(P<0.05)。2研究组术后肩关节屈曲、外展、外旋、内旋功能损伤程度明显低于对照组(P<0.01)。3术前1 d、术后2周时,研究组和对照组CD4+、CD8+、CD4+/CD8+T淋巴细胞及IL-2水平比较差异均无统计学意义(P>0.05)。术后4周时,与对照组比较,研究组CD4+、CD4+/CD8+T淋巴细胞及IL-2水平均明显升高,差异有统计学意义(P<0.05);而CD8+T淋巴细胞比例明显降低,差异有统计学意义(P<0.05)。4 2组术后5年死亡率和复发率比较差异均无统计学意义(P>0.05)。结论早期乳腺癌前哨淋巴结活检是安全、可靠的,相对于传统的腋窝淋巴结清扫术,其可以明显改善患者的术后免疫功能及生活质量。Objective To evaluate the effects of sentinel lymph node biopsy following total mastectomy on immunologic function and prognosis for patients with early breast cancer. Methods Two hundred and eleven patients with early breast cancer were entered in this study. In all these cases, the results of sentinel lymph node biopsy were negative. These patients were randomly divided into control group and research group. In 86 cases of control group, the sentinel lymph node biopsy and axillary lymph node dissection following totat mastectomy was performed. In 125 cases of research group, the sentinel lymph node biopsy following total mastectomy was performed. The injury of shoulder joint function was analyzed in one year after surgery. The changes of T cell subsets and IL-2 level were detected in the patients respectively on the first day before operation, the second week after operation, and the fourth week after operation. Postoperative fatality rate and postoperative recurrence rate were also observed in two groups. Results ① The points of shoulder joint function in the control group and the research group were 72.7±6.5 and 93.5±8.2 respectively, there was an obvious difference （P〈0.05）. ② The injury degree of shoulder joint function in the research group was significantly lower than that in the control group （P〈0.01）. ③ Compared with the control group, the changes of T cell subsets and the IL-2 level had no significant differences in the research group on day 1 before operation and on week 2 after operation （P〉0.35）.On the fourth week after surgery, the CD4^＋ CD4^＋/CD8^＋, and IL-2 level in the research group were obviously higher than those in the control group （P〈0.05）. However, the percentage of CD8^＋ T cell in the research group was significantly lower than that in the control group （P〈0.05）. ④ There were no significant differences for postoperative fatality rate and postoperative recurrence rate between two groups （P〉0.05）. Conclusions Sentinel lymph node biopsy

关 键 词：早期乳腺癌 前哨淋巴结活检 免疫功能 预后 

分 类 号：R737.9[医药卫生—肿瘤]