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 on immunologic function and prognosis of early breast cancer patients after operation by sentinel lymph node biopsy following total mastectomy

作　　者：徐旭东 卢建芹[2] 黄继玲 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,武汉430050 [2]武汉华中科技大学同济医学院附属同济医院肿瘤科,430030 [3]武汉华中科技大学同济医学院附属同济医院甲乳外科,430030

出　　处：《国际外科学杂志》2015年第5期310-313,共4页International Journal of Surgery

基　　金：国家自然科学基金（No.81302309）

摘　　要：目的 探讨前哨淋巴结活检对早期乳腺癌患者术后免疫功能的改善作用,并分析其对患者预后的影响.方法 211例前哨淋巴结活检阴性的早期乳腺癌患者按随机化原则随机分为对照组（n=86）和研究组（n=125）,其中对照组均行乳房切除术加前哨淋巴结活检加腋窝淋巴结清扫术,研究组均行乳房切除术加前哨淋巴结活检.分析两组患者术后1年肩关节功能损伤情况,并比较患者术后2周、术后4周T细胞亚群和IL-2的变化,同时观察患者术后5年病死率和复发率.结果 对照组和研究组术后Neer肩关节功能评分分别为（72.7±6.5）分、（93.5±8.2）分,两者之间差异有统计学意义（P＜0.05）,研究组术后肩关节屈曲、外展、外旋、内旋等功能损伤程度明显低于对照组（P＜0.01）.术后2周,对照组CD4^＋T细胞、CD8^＋T细胞比例分别为（32.86±2.58）％、（34.66±3.05）％,研究组CD4^＋T细胞、CD8^＋T细胞比例分别为（33.21±2.60）％、（34.98±3.13）％,两者之间比较差异均无统计学意义（P＞0.05）.对照组IL-2水平为（1.29 ±0.22） μg/L,研究组IL-2水平为（1.27±0.17） μg/L,两者之间比较差异无统计学意义（P＞0.05）.术后4周,对照组CD4^＋T细胞、CD8^＋T细胞比例分别为（38.65±2.62）％、（26.56±2.57）％,研究组CD4^＋T细胞、CD8^＋T细胞比例分别为（44.45±3.34）％、（22.85±2.43）％,两者之间比较差异均具有统计学意义（P＜0.05）.对照组IL-2水平为（1.40±0.34） μg/L,研究组IL-2水平为（1.61±0.42） μg/L,两者之间差异有统计学意义（P＜0.05）.对照组与研究组术后5年病死率和复发率之间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 explore the effects on immunologic function and prognosis of early breast cancer patients after operation by sentinel lymph node biopsy following total mastectomy,furthermore,the author will evaluate the effect on prognosis.Methods Two hundred and eleven cases of early-phase breast cancer patients entered the study.In all these cases,the results of sentinel lymph node biopsy showed negative.They were divided into control group and research group in terms of balanced random groups.In 86 cases of control group,adopted sentinel lymph node biopsy and axillary lymph node dissection following total mastectomy,while affected sentinel lymph node biopsy following total mastectomy in 125 cases of research group.The injury of shoulder joint function was analyzed on 1 year after surgery.The changes of T cell subset,IL-2 were detected in the patients respectively in the first day before operation,in 2 weeks after operation,in 4 weeks after operation.Postoperative fatality rate and postoperative recurrence rate were also observed in two groups.Results The scores of shoulder joint function in control group and research group were （72.7 ± 6.5） and （93.5 ± 8.2）,there was obvious difference（P 〈 0.05）.Furthermore,the injury of shoulder joint function in research group was significantly lower than that in control group（P 〈 0.01）.Compared with control group,the changes of T cell subset,IL-2 had no significant differences in research group in 2 weeks after operation（P 〉0.05）.In four weeks after surgery,the levels of CD4^＋ （38.65 ± 2.62）% in control group were obviously lower than those （44.45 ± 3.34） % in research group（P 〈 0.05）.However,the percentage of CD8^＋T cells（26.56 ± 2.57） % in control group was significantly higher than that （22.85 ± 2.43） % in research group（P 〈 0.05）.The levels of IL-2 in control group and research group were （1.40 ± 0.34） μg/L and （1.61 ±0.42）μg/L,and there were obvious differences（P 〈 0.05）.There were no signif

关 键 词：乳腺肿瘤 前哨淋巴结活组织检查 免疫功能 预后 

分 类 号：R737.9[医药卫生—肿瘤]