乳腺癌改良根治术术中行胸肌间淋巴结清扫术对患者近远期临床预后的影响

摘要

目的：探讨乳腺癌改良根治术术中行胸肌间淋巴结(IPNs)清扫对患者近远期预后的影响。方法采用前瞻性研究，长期随访我院2000年3月至2005年6月接受乳腺癌改良根治术的127例患者，其中61例术中行IPNs清扫，66例未行IPNs清扫，所有患者均随访至2016年6月，比较近期和远期预后。结果清扫组患者切缘阴性率为96.72%，未清扫组为98.48%，差异无统计学意义(P>0.05)；清扫组患者的并发症发生率为29.51%，未清扫组为24.24%，差异无统计学意义(P>0.05)；清扫组3年、5年、10年无病生存率分别为88.52%、72.77%、63.93%，未清扫组分别为77.27%、62.12%、53.03%，清扫组患者3年、5年、10年总生存率分别为95.08%、81.97%、72.13%，未清扫组分别为83.33%、69.70%、59.09%，清扫组均高于未清扫组，差异均有统计学意义(P<0.05)；清扫组患者局部复发和远处转移率分别为9.84%、26.23%，均低于未清扫组的19.70%、36.36%，差异均有统计学意义(P<0.05)。结论乳腺癌改良根治术术中行IPNs清扫可提高患者无病生存率和总生存率，提示应重视IPNs，并建议术中常规清扫IPNs，提高患者预后。%Objective To explore the influences of the surgical dissection of interpectoral lymph nodes (IPNs) in the operation of modified radical mastectomy of breast cancer on the short-term and long-term prognosis of patients. Methods In the prospective study, 127 patients underwent modified radical mastectomy for breast cancer in our hospi-tal from March 2000 to June 2005 were selected as the research subjects. Among of which, 61 patients underwent IPNs dissection and 66 without IPNs. All patients were followed up to June 2016, and the recent and long-term prognosis was compared. Results The negative rates of resection in the patients undergoing IPNs dissection and without IPNs dissec-tion were 96.72%and 98.48%, respectively, and the difference was not statistically significant (P>0.05). The complication rates of the patients undergoing IPNs dissection and without IPNs dissection were 29.51%and 24.24%, respectively, and the difference was not statistically significant (P>0.05). The disease-free survival rates and overall survival rates of the pa-tients undergoing IPNs dissection in 3 years, 5 years, 10 years were respectively 88.52%, 72.77%, 63.93%and 95.08%, 81.97%, 72.13%, which were higher than 77.27%, 62.12%, 53.03%and 83.33%, 69.70%, 59.09%(P<0.05). The local re-currence rate and distant metastasis rate of the patients undergoing IPNs dissection were 9.84%and 26.23%, respectively, which were significantly lower than 19.70%and 36.36%of the uncleaned group (P<0.05). Conclusion The surgical dissection of IPNs in the operation of modified radical mastectomy of breast cancer can improve disease-free survival and overall survival, which indicates that attention should be paid to IPNs. The surgical dissection of IPNs should be per-formed in the operation of modified radical mastectomy of breast cancer, which can improve the prognosis of patients.