乳腺癌患者保乳术联合腔镜腋窝淋巴结清扫术的临床研究  

Clinical study in breast-conserving surgery combined with mastoscopic axillary lymph node dissection in patients with breast cancer

作　　者：笪霞 纪璟 朱春花[1] 王国柱[1] 徐锦[1] DA Xia;JI Jing;ZHU Chunhua;WANG Guozhu;XU Jin(Department of Thyroid and Breast Surgery,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing First Hospital,Nanjing,Jiangsu,210000)

机构地区：[1]南京医科大学附属南京医院/南京市第一医院甲乳外科,江苏南京210000

出　　处：《实用临床医药杂志》2022年第8期49-53,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省南京市卫生科技发展专项资金项目(YKK20113)。

摘　　要：目的探讨保乳手术联合腔镜腋窝淋巴结清扫术(MALND)对乳腺癌患者上肢功能、应激反应及血管细胞黏附分子-1(VCAM-1)、细胞间黏附分子-1(ICAM-1)水平的影响。方法回顾性分析98例乳腺癌患者的临床资料,依据手术方式的不同分为研究组53例和对照组45例。对照组行保乳手术联合传统腋窝淋巴结清扫术(CALND),研究组行保乳手术联合MALND。比较2组术前、术后6个月上肢功能;收集2组患者术前、术后12 h焦虑自评量表(SAS)、抑郁自评量表(SDS)评分以及心率(HR)、平均动脉压(MAP)水平,并对比2组应激反应程度;比较2组患者术前、术后5 d VCAM-1、ICAM-1水平。结果术后6个月,研究组前屈、后伸、内收、外展、内旋、外旋活动角度大于对照组,差异有统计学意义(P<0.05);术后12 h,研究组SAS、SDS评分及HR、MAP水平低于对照组,差异有统计学意义(P<0.05);术后5 d,研究组VCAM-1、ICAM-1水平低于对照组,差异有统计学意义(P<0.05)。结论保乳手术联合MALND对乳腺癌患者上肢功能影响小,术后应激反应程度轻,可有效降低VCAM-1、ICAM-1水平。Objective To explore the effect of breast-conserving surgery combined with mastoscopic axillary lymph node dissection(MALND)on upper limb function,stress response,vascular cell adhesion molecule-1(VCAM-1)and intercellular adhesion molecule-1(ICAM-1)levels in breast cancer patients.Methods The clinical data of 98 patients with breast cancer were retrospectively analyzed,and they were divided into study group(53 cases)and control group(45 cases)according to different surgical methods.The control group received breast-conserving surgery combined with traditional conventional axillarylymph node dissection(CALND),and the study group received breast-conserving surgery combined with MALND.The upper limb function before and 6 months after operation was compared between the two groups;Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS)scores,heart rate(HR)and mean arterial pressure(MAP)levels of two groups were collected before and 12 h after surgery,and stress response degree of two groups was compared;the VCAM-1and ICAM-1 levels were compared between two groups before surgery and 5 days after surgery.Results Six months after surgery,the activity angles of flexion,extension,adduction,abduction,pronation and pronation in the study group were significantly larger than those in the control group(P<0.05);at 12 h after operation,the scores of SAS and SDS,HR and MAP levels in the study group were significantly lower than those in the control group(P<0.05);at 5 days after surgery,the levels of VCAM-1 and ICAM-1 in the study group were significantly lower than those in the control group(P<0.05).Conclusion Breast-conserving surgery combined with MALND has less influence on upper limb function of breast cancer patients,and the degree of postoperative stress response is lighter,which can effectively reduce the levels of VCAM-1 and ICAM-1.

关 键 词：乳腺癌 保乳手术 腔镜腋窝淋巴结清扫术 上肢功能 应激反应 血管细胞黏附分子-1 细胞间黏附分子-1 

分 类 号：R737.9[医药卫生—肿瘤] R61[医药卫生—临床医学]