早期乳腺癌不同手术治疗方案的安全性、临床疗效及对患者生活质量的影响

摘要

目的 探讨早期乳腺癌不同手术治疗方案的临床疗效、安全性及对患者生活质量的影响.方法 选取132例早期乳腺癌患者,按随机数字法将患者分为对照组和观察组.对照组患者采用肿瘤部位的放射状或弧状切口,切口距肿瘤外缘>2 cm.观察组采用以乳头为中心的纵(横)梭形切口,切口距肿瘤外缘>3.0 cm.记录患者手术过程的手术时间、乳房外观、住院时间及出血量,并对患者进行定期回访,统计术后3年的生活质量、远处转移率、局部复发率及生存率.结果 观察组的手术时间[(41.32 ±11.54)min]、住院时间[(6.61 ±1.44)d]、出血量[(36.82 ±7.16)mL]及乳房外观优良率(89.39%)明显优于对照组手术时间[(96.78 ±13.69)min]、住院时间[(10.34 ±1.81)d]、出血量[(81.27 ±13.31)mL]及乳房外观优良率(49.48%)(P<0.05).观察组患者的生理功能、情感职能、活力及精神健康评分明显优于对照组(P<0.05);但观察组的躯体疼痛评分与对照组无明显区分(P>0.05).观察组患者的远处转移率(31.82%)、局部复发率(34.85%)及3年生存率(62.12%)明显差于对照组的远处转移率(25.76%)、局部复发率(28.79%)及3年生存率(74.24%)(P<0.05).结论 采用以乳头为中心的纵(横)梭形切口治疗早期乳腺癌患者可有效改善患者乳房的外观,最大限度地保留患者的生理结构,提升患者的生活质量,但远期疗效欠佳.%Objective To investigate the clinical efficacy,safety and the impact on the quality of life in patients with early breast cancer treated with different surgical protocols.Methods 132 cases of early breast cancer patients were selected by random sampling.Patients were randomly divided into the control group and the observation group.The control group was treated with tumor radial or arc incision,incision from the tumor edge≥2 cm.The observation group with the nipple as the center of the vertical(horizontal)fusiform incision,incision from the tumor edge≥3 cm.The operation time,blood loss,length of hospital stay and appearance of the patients and the quality of life,distant metastasis rate,local recurrence rate and 3-year survival rate were re-corded.Results The operation time of the observation group was 41.32 ±11.54 min,hospitalization time 6.61 ±1.44 d,blood loss 36.82 ±7.16 mL and the excellent rate of breast appearance 89.39%,which were significantly better than the control group operation time 96.78 ±13.69 min,hospitalization time 10.34 ±1.81 d,blood loss 81.27 ±13.31 mL and the excellent rate of breast appearance 49.48%(P<0.05).The observation group were significantly better than the control group in the physiological function,vitality,emotional function and mental health score(P<0.05);but there was no significant difference between the ob-servation group and the control group in body pain score(P>0.05).The observation group of patients with distant metastasis 21 cases(31.82%),the local recurrence 23 cases(34.85%)and 3-year survival 41 cases(62.12%)were significantly poorer than those of the control group the distant metastasis 17 cases(25.76%),the local recurrence 19 cases(28.79%)and 3-year survival 49 cases(74.24%)(P<0.05).Conclusion The nipple as the center of the vertical(horizontal)fusiform appearance incision in the treatment of early breast cancer patients could effectively improve breast beautuy,keep the patient's physiological structure to maximize,enhanced the quality of life of patients,but the long-term effect is poor.