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目的探讨保乳手术对早期乳腺癌患者近期及远期预后的影响,为早期乳腺癌治疗提供临床依据。方法 78例早期乳腺癌患者作为研究对象,根据手术方法不同分为保乳手术组(41例)和改良根治术组(37例)。比较两组患者手术情况、术后并发症发生情况、术后乳房美容效果、术后近远期预后、术前及术后生活质量。结果 (1)保乳手术组手术时间、术中出血量、住院时间均优于改良根治术组,差异均有统计学意义(t=-5.948、-21.174、-10.944,P<0.05)。(2)保乳手术组术后上肢水肿、皮下积液发生率分别为4.88%、7.32%,均低于改良根治术组的21.62%、24.32%,差异均有统计学意义(χ~2=4.878、4.321,P<0.05)。(3)保乳手术组乳房美容效果优良率为95.12%,高于改良根治术组的59.46%,差异有统计学意义(χ~2=14.512,P<0.05)。(4)两组患者术后1年生存率均为100.00%,无复发和远处转移患者,差异均无统计学意义(χ~2=0.000、0.000、0.000,P>0.05);两组术后5年生存率、复发率及远处转移率比较,差异均无统计学意义(χ~2=0.065、0.134、0.079,P>0.05)。(5)保乳手术组患者术后6个月、1年、5年生活质量评分低于改良根治术组,差异均有统计学意义(t=-4.649、-6.489、-4.178,P<0.05)。结论保乳手术与改良根治术均是治疗早期乳腺癌的有效手段,但保乳手术明显减轻对患者的创伤,改善了乳房美容效果及术后生活质量,值得临床重视。
Objective To investigate the effect of breast-conserving surgery on the prognosis of patients with early-stage breast cancer and provide the clinical evidence for the treatment of early-stage breast cancer. Methods A total of 78 patients with early breast cancer were divided into two groups: breast conserving surgery group (41 cases) and modified radical mastectomy group (37 cases). The operation conditions, postoperative complications, postoperative breast cosmetic results, postoperative short and long term prognosis, preoperative and postoperative quality of life were compared between the two groups. Results (1) The operation time, intraoperative blood loss and hospital stay in breast-conserving surgery group were all better than those in modified radical mastectomy group (t = -5.948, -21.174, -10.944, P <0.05). (2) The incidences of postoperative upper extremity edema and subcutaneous effusion in breast conserving surgery group were 4.88% and 7.32%, which were all lower than 21.62% and 24.32% in modified radical mastectomy group (χ ~ 2 = 4.878,4.321, P <0.05). (3) The breast-beautifying effect in breast-conserving surgery group was 95.12%, which was significantly higher than 59.46% in modified radical mastectomy group (χ ~ 2 = 14.512, P <0.05). (4) The 1-year survival rates of both groups were 100.00%, there was no significant difference between the two groups (χ ~ 2 = 0.000, 0.000, 0.000, P> 0.05) There was no significant difference in survival rate, recurrence rate and distant metastasis rate after 5 years (χ ~ 2 = 0.065,0.134,0.079, P> 0.05). (5) The scores of quality of life in breast conserving surgery group at 6 months, 1 year and 5 years after operation were lower than those in modified radical operation group (t = -4.649, -6.489, -4.178, P <0.05) ). Conclusions Both breast-conserving surgery and modified radical mastectomy are effective methods for the treatment of early-stage breast cancer. However, breast-conserving surgery can significantly reduce trauma to patients and improve breast cosmetic results and quality of postoperative life, which deserves clinical attention.