新辅助化疗对乳腺癌改良根治术后并发症及凝血功能的影响  

Effect of neoadjuvant chemotherapy on complications and coagulation function after modified radical mastectomy

作　　者：邓玉燕 庞永慧[2] 莫钦国[2] 谭虹虹[2] 茅传兰[2] 陈菲菲 Deng Yuyan;Pang Yonghui;Mo Qinguo;Tan Honghong;Mao Chuanlan;Chen Feifei(Department of Nursing,Maternity and Child Healthcare Hospital of Guangxi Zhuang Autonomous Region,Nanning 530003,China;Department of Breast Surgery,Cancer Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西壮族自治区妇幼保健院护理部,南宁530003 [2]广西医科大学附属肿瘤医院乳腺外科,南宁530021

出　　处：《中华乳腺病杂志（电子版）》2021年第5期283-287,共5页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：目的探讨新辅助化疗是否影响乳腺癌患者改良根治术后的并发症和凝血功能。方法回顾性分析2016年9月至2019年12月在广西医科大学附属肿瘤医院乳腺中心行改良根治术的110例乳腺癌患者临床资料,其中53例接受8周期多柔比星+环磷酰胺序贯多西他赛(AC-T)新辅助化疗为新辅助化疗组(NCT组),57例未接受新辅助化疗患者为对照组。采用两独立样本t检验比较2组患者手术情况(手术时间、术中出血量和术后引流量),采用χ^(2)检验或Fisher确切概率检验比较2组患者的淋巴结转移率和术后并发症发生率(皮下积液、皮瓣坏死、患肢水肿、感染和静脉血栓),采用重复测量方差分析比较术前1 d、术后1 d和术后7 d患者的凝血功能相关指标[血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)及D-二聚体]的差异。结果(1)2组患者间手术时间、术中出血量、总引流量和淋巴结转移率比较,差异均无统计学意义(t=0.164,P=0.870;t=-0.584,P=0.560;t=-0.340,P=0.734;χ^(2)=0.182,P=0.669);(2)2组患者间术后皮下积液、皮瓣坏死、患肢水肿、感染和静脉血栓发生率比较,差异均无统计学意义(χ^(2)=0.036,P=0.849;P=1.000;χ^(2)=0.182,P=0.670;P=1.000;P=0.230);(3)PLT、PT、APTT、TT、FIB和D-二聚体组内变异中的时间因素差异有统计学意义(F=8.826,P<0.001;F=3.210,P=0.044;F=3.491,P=0.032;F=24.811,P<0.001;F=72.847,P<0.001;F=267.238,P<0.001);APTT、FIB和D-二聚体组间变异中的组别因素比较,差异有统计学意义(F=5.854,P=0.017;F=4.616,P=0.034;F=7.761,P=0.006);而所有凝血功能指标无交互效应(F=2.045,P=0.134;F=0.998,P=0.372;F=1.340,P=0.264;F=0.302,P=0.740;F=0.305,P=0.737;F=1.703,P=0.187)。结论8个周期AC-T新辅助化疗方案并不会增加乳腺癌改良根治术后并发症的发生率,但可使APTT缩短,FIB及D-二聚体显著升高,导致乳腺癌患者术后血液高凝状态的产生�Objective To investigate the effect of neoadjuvant chemotherapy(NCT)on the complications and coagulation function after modified radical mastectomy.Methods A retrospective analysis was performed on the clinical data of 110 patients who underwent modified radical mastectomy in the Department of Breast Surgery,Cancer Hospital of Guangxi Medical University from September 2016 to December 2019.Fifty-three patients received 8 cycles of NCT(doxorubicin and cyclophosphamide followed by docetaxel,AC-T)(NCT group)and 57 patients underwent modified radical mastectomy but received no NCT(control group).The operation parameters(operation time,intraoperative hemorrhage and total drainage volume)were compared between two groups by t-test of two independent samples.The incidences of lymph node metastasis postoperative complications(subcutaneous hydrops,skin flap necrosis,edema of affected limb,infection and venous thrombosis)were compared between two groups by χ^(2) test or Fisher exact probability test.The related parameters of coagulation function[platelet count(PLT),prothrombin time(PT),activated partial thrombin time(APTT),thrombin time(TT),fibrinogen(FIB)and D-dimer]were compared at different time points(1 day before operation,1 day and 7 days after operation)by ANOVA analysis of repeated measurements.Results(1)There was no significant difference in operation time,intraoperative hemorrhage,total drainage and lymph node metastasis rate between two groups(t=0.164,P=0.870;t=-0.584,P=0.560;t=-0.340,P=0.734;χ^(2)=0.182,P=0.669).(2)There was no significant difference in the incidences of postoperative subcutaneous hydrops,flap necrosis,limb edema,infection and venous thrombosis between two groups(χ^(2)=0.036,P=0.849;P=1.000;χ^(2)=0.182,P=0.670;P=1.000;P=0.230).(3)PLT,PT,APTT,TT,FIB and D-dimer showed a significant difference between different time points(F=8.826,P<0.001;F=3.210,P=0.044;F=3.491,P=0.032;F=24.811,P<0.001;F=72.847,P<0.001;F=267.238,P<0.001).APTT,FIB and D-dimer showed a significant difference between groups(F=5.

关 键 词：乳腺肿瘤 药物疗法 联合 手术后并发症 

分 类 号：R737.9[医药卫生—肿瘤]