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  

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

作　　者：王春姝 李欣[1] 温健[1] 李萍萍 WANG Chunshu;LI Xin;WEN Jian;LI Pingping(Department of Anesthesiology,the First Affiliated Hospital of Xi’an Jiaotong University,Shaanxi Province,Xi’an 710061,China;Medical Transformation Center,the First Affiliated Hospital of Xi’an Jiaotong University,Shaanxi Province,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院麻醉科,陕西西安710061 [2]西安交通大学第一附属医院医学转化中心,陕西西安710061

出　　处：《中国医药导报》2020年第36期105-109,共5页China Medical Herald

基　　金：国家自然科学基金资助项目(81702631)。

摘　　要：目的探讨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。方法选取西安交通大学第一附属医院2015年10月—2017年10月收治的92例早期乳腺癌患者临床资料进行研究,其中44例行保乳手术联合前哨淋巴结活检术(观察组),48例行改良根治术(对照组)。比较两组围术期参数(手术耗时、术中出血量、总引流量、腋窝拔管时间、住院时间),手术前后肩关节活动度(外旋、内旋、后伸、外展、屈曲),并发症发生率,乳房美容满意度以及问卷的效度及信度分析结果,术后乳腺癌人群特异性问卷(QLQ-BR23)评分及术后随访结果。结果观察组手术耗时长于对照组,术中出血量、总引流量均少于对照组,腋窝拔管时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。术后6个月,两组肩关节外旋、内旋、后伸、外展、屈曲度均较术前减小(P<0.05),但观察组均大于对照组(P<0.05)。观察组并发症发生率低于对照组(P<0.05)。观察组术后6个月乳房美容满意度高于对照组(P<0.05)。自制乳房美容满意度调查问卷量表的信效度:Cronbach’sα系数为0.854,重测信度为0.836。对量表的内容效度进行检测内容效度指数为0.817。观察组术后6个月QLQ-BR23问卷体象、性功能、性愉悦、对未来的看法评分均高于对照组,乳房症状、上肢症状评分均低于对照组(P<0.05);两组脱发烦恼、治疗副作用评分比较,差异均无统计学意义(P>0.05)。术后随访1年,两组生存、复发及转移率比较,差异均无统计学意义(P>0.05)。结论早期乳腺癌患者采用保乳手术联合前哨淋巴结活检术治疗,可获得与改良根治术接近的疗效,但术后患者恢复快,对乳房美观及日常生活活动功能影响较小。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�

关 键 词：保乳手术 前哨淋巴结活检术 早期乳腺癌 腋窝拔管时间 肩关节活动度 远期疗效 

分 类 号：R737.9[医药卫生—肿瘤]