新辅助化疗对腔镜乳腺癌改良根治加假体植入术后并发症及疗效影响

发布时间：2018-07-23 16:40

【摘要】：乳腺癌近几年一直位居女性恶性肿瘤发病率首位,同时发病率逐年上升。随着乳腺癌综合治疗的不断发展,其预后已经取得明显改善。随着腔镜技术的不断发展,其在乳腺外科的应用已越来越多。腔镜乳腺癌改良根治+假体植入乳房重建术是在完成病灶切除和淋巴结切除后一期植入假体重建乳房,从而最大限度的改善美容效果。其与传统改良根治术的不同的是完整保留了乳头乳晕以及皮肤,在切除病灶的同时仅通过小切口将皮下腺体和淋巴结组织整块切除,对比后者的优势在于不仅能够确保同样的手术效果,还能因为术后一期假体植入取得更佳的外观,很大程度上缓解患者术后的心理落差,使其拥有更佳的生活质量。新辅助化疗作为乳腺癌综合治疗手段中的重要部分,是乳腺癌患者术前一种重要的治疗手段。许多文献报道其对传统改良根治术后并发症无明显影响,主要认为其不增加术后并发症的发生率,同时也不会影响远期疗效。但新辅助化疗对腔镜乳腺癌改良根治加假体植入术的并发症和疗效是否有明显影响,目前文献报道尚少。因此,本课题拟采用回顾性研究及前瞻性随机对照研究的方法研究新辅助化疗对腔镜乳腺癌改良根治加假体植入乳房重建术的手术并发症及疗效的影响,为临床乳腺癌腔镜手术的规范化治疗提供依据。研究方法和主要结果1.新辅助化疗对腔镜辅助乳腺癌手术后并发症及疗效的影响的回顾性研究方法:收集从2007年到2010年第三军医大学西南医院乳腺中心总共183例确诊并实施腔镜辅助手术治疗的乳腺癌患者的详细基本资料,根据术前是否进行新辅助化疗将其分成两组,其中对照组共85例,经确诊后首先给予腔镜辅助手术治疗,术后给予辅助化疗。而剩余98例为新辅助化疗组,首先给予2-4个周期的新辅助化疗,随后实施腔镜辅助手术。对比两组手术情况、术后并发症和远期疗效。结果:(1)nct组与对照组在手术时间(213.0±36.0vs215.1±38.5,p=0.704)、出血量(79.0±24.3vs74.1±20.0,p=0.144)、引流量(274.3±92.4vs283.7±80.1,p=0.469)方面差异均无统计学意义。(2)两组在术后感染(3/98vs5/85,p=0.475)、乳头或皮瓣坏死(6/98vs5/85,p=0.946)以及上肢水肿发生率(8/98vs12/85,p=0.291)方面亦无统计学差异。(3)随访至2015年3月31日(9~92个月),其中中位随访时间为66个月,两组患者局部复发率(2/98vs2/85,p=1.000)、远处转移率(12/98vs9/85,p=0.726)及死亡率(6/98vs4/85,p=0.925)之间无明显差异。2.新辅助化疗对乳腺癌腔镜改良根治加假体植入乳房重建术后并发症和疗效影响的前瞻性随机对照研究方法:纳入自2013年1月1日起在西南医院乳腺中心住院并实施腔镜改良根治加假体植入乳房重建术治疗病人共110例。病人入组后随机分成两组,其中直接进行腔镜手术的为对照组,共53例,首先给予2-4个周期新辅助治疗的为新辅助化疗组,总共57例。比较两组手术情况、术后美观度、术后并发症和远期疗效。结果:(1)nct组与对照组在手术时间(204.8±70.1vs210.3±68.3,p=0.674)、出血量(77.7±71.9vs72.8±61.2,p=0.703)、引流量(263.5±67.6vs255.1±77.3,p=0.544)差异无统计学意义。(2)两组在术后感染或积液(5/57vs6/53,p=0.656)、乳头或皮瓣坏死(5/57vs5/53,p=0.904)以及上肢水肿发生率(7/57vs6/53,p=0.876)方面亦无统计学差异(3)两组患者术后美观度的差异无统计学意义(p0.05),绝大部分都属于优良,但是nct组优良率略高于对照组(64.7%vs61.23%)。(3)随访至2015年4月30日(2~27个月),中位随访时间为12个月,两组皆无1例患者出现局部复发,仅有2例发生远处转移,两组各1例。两组均未有死亡病例。结论回顾性和前瞻性随机对照研究皆说明了新辅助化疗不会增加腔镜乳腺癌改良根治术后并发症的发生率,乳腺癌患者在新辅助化疗后进行腔镜手术加假体植入乳房重建是安全有效的。
[Abstract]:Breast cancer has been the highest incidence of malignant tumor in women in recent years, and the incidence of breast cancer has increased year by year. With the continuous development of comprehensive breast cancer treatment, the prognosis has been improved obviously. With the continuous development of endoscopic technology, more and more applications of breast cancer in breast surgery have been made. In contrast to the traditional modified radical mastectomy, the nipple areola and the skin were retained, and the subcutaneous glands and lymph nodes were excised by a small incision and compared with the conventional modified radical mastectomy. The advantage of this is not only to ensure the same effect, but also to make a better appearance after the first phase of the prosthesis, to a great extent, to relieve the psychological drop of the patient and to have better quality of life. As an important part of the comprehensive treatment of breast cancer, neoadjuvant chemotherapy is a heavy pre operation of breast cancer patients. Many documents have reported that it has no obvious effect on the complications after traditional modified radical mastectomy, and it is mainly considered that it does not increase the incidence of postoperative complications and does not affect the long-term effect. However, new adjuvant chemotherapy has a significant impact on the combination of modified radical mastectomy and prosthesis implantation for endoscopic breast cancer. Therefore, we should use a retrospective study and prospective randomized controlled study to study the effect of neoadjuvant chemotherapy on the complications and curative effect of modified radical mastectomy and prosthesis implantation for breast cancer, and to provide the basis for the standardized treatment of endoscopic surgery for breast cancer. The research methods and main results are 1 A retrospective study of the effects of neoadjuvant chemotherapy on postoperative complications and efficacy of endoscopic assisted breast cancer surgery: a total of 183 cases of breast cancer in the breast center of Southwest Hospital of Third Military Medical University from 2007 to 2010 were collected and the detailed basic information of breast cancer patients treated by endoscopic assisted surgery was carried out according to whether neoadjuvant chemotherapy was performed before the operation. The control group was divided into two groups, of which 85 cases in the control group were first given endoscopic assisted surgery and adjuvant chemotherapy after operation. The remaining 98 cases were neoadjuvant chemotherapy group, first given 2-4 cycles of neoadjuvant chemotherapy, and then performed endoscopic assisted surgery. Compared the two groups of operations, postoperative complications and long-term effect. Results: (1) NCT group The operation time (213 + 36.0vs215.1 + 38.5, p=0.704), bleeding volume (79 + 24.3vs74.1 + 20, p=0.144), flow rate (274.3 + 92.4vs283.7 + 80.1, p=0.469) were not statistically significant. (2) two groups were infected (3/98vs5/85, p=0.475), nipple or flap necrosis (6/98vs5/85, p=0.946) and the incidence of upper limb edema (8/98) two There was no statistical difference in vs12/85, p=0.291). (3) follow up to March 31, 2015 (9~92 months), of which the median follow-up time was 66 months, the local recurrence rate (2/98vs2/85, p=1.000) in the two groups, the distant metastasis rate (12/98vs9/85, p=0.726) and the mortality (6/ 98vs4/85, p=0.925) were not significantly different from the.2. neoadjuvant chemotherapy to breast cancer endoscopy. A prospective randomized controlled study of the complications and effects of breast prosthesis implantation after breast reconstruction: a total of 110 patients were hospitalized in the breast center of Southwest Hospital since January 1, 2013 and treated by endoscopic modified radical mastectomy and prosthesis implantation. The patients were randomly divided into two groups, including direct cavity. A total of 53 cases in the control group were given a total of 53 cases. First, the new adjuvant chemotherapy group was given 2-4 cycles, a total of 57 cases. The two groups of operations, postoperative aesthetics, postoperative complications and long-term effect were compared. (1) the operation time (204.8 + 70.1vs210.3 + 68.3, p=0.674), and the amount of bleeding (77.7 + 71.9vs72.8 + 61.2, p=0.70) in the group and the control group. 3) there was no significant difference in the flow rate (263.5 + 67.6vs255.1 + 77.3, p=0.544). (2) there was no significant difference in postoperative infection or effusion (5/57vs6/53, p=0.656), papilla or flap necrosis (5/57vs5/53, p=0.904) and the incidence of upper limb edema (7/57vs6/53, p=0.876) in the two groups (3) there was no statistical difference between the two groups (P). 0.05) most of them were excellent, but the good rate of NCT group was slightly higher than that of the control group (64.7%vs61.23%). (3) follow up to April 30, 2015 (2~27 months), the median follow-up time was 12 months. The two groups had no 1 cases with local recurrence, only 2 cases had distant metastasis and two groups were 1. None of the two groups were dead. Conclusions retrospective and prospective. The randomized controlled study shows that neoadjuvant chemotherapy does not increase the incidence of complications after modified radical mastectomy for endoscopic breast cancer. It is safe and effective for breast cancer patients to undergo endoscopic surgery and prosthetic reconstruction after neoadjuvant chemotherapy.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9

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