CAJ | 학술논문

目的探讨前哨淋巴结活检对早期乳腺癌患者术后免疫功能的改善作用,并分析其对患者预后的影响.方法 211例前哨淋巴结活检阴性的早期乳腺癌患者按随机化原则随机分为对照组(n=86)和研究组(n=125),其中对照组均行乳房切除术加前哨淋巴结活检加腋窝淋巴结清扫术,研究组均行乳房切除术加前哨淋巴结活检.分析两组患者术后1年肩关节功能损伤情况,并比较患者术后2周、术后4周T细胞亚群和IL-2的变化,同时观察患者术后5年病死率和复发率.结果对照组和研究组术后Neer肩关节功能评分分别为(72.7±6.5)分、(93.5±8.2)分,两者之间差异有统计学意义(P＜0.05),研究组术后肩关节屈曲、外展、外旋、内旋等功能损伤程度明显低于对照组(P＜0.01).术后2周,对照组CD4+T细胞、CD8+T细胞比例分别为(32.86±2.58)％、(34.66±3.05)％,研究组CD4+T细胞、CD8+T细胞比例分别为(33.21±2.60)％、(34.98±3.13)％,两者之间比较差异均无统计学意义(P＞0.05).对照组IL-2水平为(1.29 ±0.22) μg/L,研究组IL-2水平为(1.27±0.17) μg/L,两者之间比较差异无统计学意义(P＞0.05).术后4周,对照组CD4+T细胞、CD8+T细胞比例分别为(38.65±2.62)％、(26.56±2.57)％,研究组CD4+T细胞、CD8+T细胞比例分别为(44.45±3.34)％、(22.85±2.43)％,两者之间比较差异均具有统计学意义(P＜0.05).对照组IL-2水平为(1.40±0.34) μg/L,研究组IL-2水平为(1.61±0.42) μg/L,两者之间差异有统计学意义(P＜0.05).对照组与研究组术后5年病死率和复发率之间差异均无统计学意义(P＞0.05).结论早期乳腺癌前哨淋巴结活检是安全可靠的,相对于传统的腋窝淋巴结清扫术,其可以明显改善患者的术后免疫功能及生活质量.
목적 탐토전초림파결활검대조기유선암환자술후면역공능적개선작용,병분석기대환자예후적영향.방법 211례전초림파결활검음성적조기유선암환자안수궤화원칙수궤분위대조조(n=86)화연구조(n=125),기중대조조균행유방절제술가전초림파결활검가액와림파결청소술,연구조균행유방절제술가전초림파결활검.분석량조환자술후1년견관절공능손상정황,병비교환자술후2주、술후4주T세포아군화IL-2적변화,동시관찰환자술후5년병사솔화복발솔.결과 대조조화연구조술후Neer견관절공능평분분별위(72.7±6.5)분、(93.5±8.2)분,량자지간차이유통계학의의(P＜0.05),연구조술후견관절굴곡、외전、외선、내선등공능손상정도명현저우대조조(P＜0.01).술후2주,대조조CD4+T세포、CD8+T세포비례분별위(32.86±2.58)％、(34.66±3.05)％,연구조CD4+T세포、CD8+T세포비례분별위(33.21±2.60)％、(34.98±3.13)％,량자지간비교차이균무통계학의의(P＞0.05).대조조IL-2수평위(1.29 ±0.22) μg/L,연구조IL-2수평위(1.27±0.17) μg/L,량자지간비교차이무통계학의의(P＞0.05).술후4주,대조조CD4+T세포、CD8+T세포비례분별위(38.65±2.62)％、(26.56±2.57)％,연구조CD4+T세포、CD8+T세포비례분별위(44.45±3.34)％、(22.85±2.43)％,량자지간비교차이균구유통계학의의(P＜0.05).대조조IL-2수평위(1.40±0.34) μg/L,연구조IL-2수평위(1.61±0.42) μg/L,량자지간차이유통계학의의(P＜0.05).대조조여연구조술후5년병사솔화복발솔지간차이균무통계학의의(P＞0.05).결론 조기유선암전초림파결활검시안전가고적,상대우전통적액와림파결청소술,기가이명현개선환자적술후면역공능급생활질량.
Objective To explore the effects on immunologic function and prognosis of early breast cancer patients after operation by sentinel lymph node biopsy following total mastectomy,furthermore,the author will evaluate the effect on prognosis.Methods Two hundred and eleven cases of early-phase breast cancer patients entered the study.In all these cases,the results of sentinel lymph node biopsy showed negative.They were divided into control group and research group in terms of balanced random groups.In 86 cases of control group,adopted sentinel lymph node biopsy and axillary lymph node dissection following total mastectomy,while affected sentinel lymph node biopsy following total mastectomy in 125 cases of research group.The injury of shoulder joint function was analyzed on 1 year after surgery.The changes of T cell subset,IL-2 were detected in the patients respectively in the first day before operation,in 2 weeks after operation,in 4 weeks after operation.Postoperative fatality rate and postoperative recurrence rate were also observed in two groups.Results The scores of shoulder joint function in control group and research group were (72.7 ± 6.5) and (93.5 ± 8.2),there was obvious difference(P ＜ 0.05).Furthermore,the injury of shoulder joint function in research group was significantly lower than that in control group(P ＜ 0.01).Compared with control group,the changes of T cell subset,IL-2 had no significant differences in research group in 2 weeks after operation(P ＞0.05).In four weeks after surgery,the levels of CD4+ (38.65 ± 2.62)％ in control group were obviously lower than those (44.45 ± 3.34) ％ in research group(P ＜ 0.05).However,the percentage of CD8+T cells(26.56 ± 2.57) ％ in control group was significantly higher than that (22.85 ± 2.43) ％ in research group(P ＜ 0.05).The levels of IL-2 in control group and research group were (1.40 ± 0.34) μg/L and (1.61 ±0.42)μg/L,and there were obvious differences(P ＜ 0.05).There were no significant differences for postoperative fatality rate and postoperative recurrence rate for five years between two groups(P ＞ 0.05).Conclusions Sentinel lymph node biopsy for early breast cancer is safe and reliable.With respect to conventional axillary lymph node dissection,it improves immune function and quality of life after surgery in patients with early breast cancer.