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目的探讨局部晚期乳腺癌根治术的疗效及患者术后生活质量和负性情绪。方法选择2011年9月至2015年2月间收治的局部晚期乳腺癌手术患者80例,其中Ⅲ期70例,Ⅳ期10例。部分患者行术前新辅助化疗,同时在无瘤区植入扩张器,行新辅助化疗时同时扩张周围正常皮肤,在化疗缩小病灶后,对其中40例(20例周围皮瓣转移,20例植入扩张器扩张周围皮肤)患者在根治术中提供足够的皮肤软组织供胸壁缺损修复,观察40例患者在接受胸壁大面积皮肤缺损修复方法治疗后的临床效果。结果局部晚期乳腺癌患者治疗后躯体功能、心理功能得分及生活质量总分均高于治疗前,差异均有统计学意义(均P<0.05)。焦虑自评量表(SAS)评分治疗后明显低于治疗前,差异有统计学意义(P<0.05)。对乳腺癌患者的随访结果显示,术后3年内80例乳腺癌患者中有6例出现局部区域复发,10例出现转移,主要转移部位为内乳淋巴结转移、锁骨上淋巴结转移,患者3年后生存68例。结论胸壁大面积皮肤缺损修复方法对局部晚期乳腺癌患者的治疗效果明显,可提高局部晚期乳腺癌患者的生活质量,有效地缓解患者术后焦虑与抑郁情绪,且术后患者转移复发率较低,生存率高。
Objective To investigate the curative effect of radical mastectomy for local advanced breast cancer and postoperative quality of life and negative emotions. Methods Eighty patients with locally advanced breast cancer treated between September 2011 and February 2015 were selected, including 70 patients with stage III and 10 patients with stage IV. Some patients were preoperatively treated with neoadjuvant chemotherapy. At the same time, dilators were implanted in the tumor-free area. At the same time, neoadjuvant chemotherapy was used to expand the surrounding normal skin. After chemotherapy, the lesions were reduced in 40 patients (20 cases of peripheral flap metastases, 20 cases). The patient was implanted with a dilator to expand the surrounding skin. The patient provided sufficient skin soft tissue for radical repair of the chest wall during radical mastectomy. The clinical effect of 40 cases of patients treated with a large area of chest wall defect repair was observed. Results The scores of somatic function, psychological function and quality of life of patients with locally advanced breast cancer after treatment were all higher than those before treatment. The differences were statistically significant (all P<0.05). The SAS score was significantly lower after treatment than before treatment, and the difference was statistically significant (P<0.05). The follow-up results of breast cancer patients showed that 6 of 80 breast cancer patients within 3 years after operation showed local recurrence and 10 patients had metastasis. The main metastatic site was internal breast lymph node metastasis and supraclavicular lymph node metastasis. The patient was 3 years later. Survival in 68 cases. Conclusion The method for repairing large area skin defect of chest wall has obvious therapeutic effect on patients with locally advanced breast cancer. It can improve the quality of life of patients with locally advanced breast cancer, effectively relieve postoperative anxiety and depression, and the rate of metastasis and recurrence after operation is low. , high survival rate.