【摘要】：乳腺癌近幾年一直位居女性惡性腫瘤發(fā)病率首位,同時(shí)發(fā)病率逐年上升。隨著乳腺癌綜合治療的不斷發(fā)展,其預(yù)后已經(jīng)取得明顯改善。隨著腔鏡技術(shù)的不斷發(fā)展,其在乳腺外科的應(yīng)用已越來(lái)越多。腔鏡乳腺癌改良根治+假體植入乳房重建術(shù)是在完成病灶切除和淋巴結(jié)切除后一期植入假體重建乳房,從而最大限度的改善美容效果。其與傳統(tǒng)改良根治術(shù)的不同的是完整保留了乳頭乳暈以及皮膚,在切除病灶的同時(shí)僅通過(guò)小切口將皮下腺體和淋巴結(jié)組織整塊切除,對(duì)比后者的優(yōu)勢(shì)在于不僅能夠確保同樣的手術(shù)效果,還能因?yàn)樾g(shù)后一期假體植入取得更佳的外觀,很大程度上緩解患者術(shù)后的心理落差,使其擁有更佳的生活質(zhì)量。新輔助化療作為乳腺癌綜合治療手段中的重要部分,是乳腺癌患者術(shù)前一種重要的治療手段。許多文獻(xiàn)報(bào)道其對(duì)傳統(tǒng)改良根治術(shù)后并發(fā)癥無(wú)明顯影響,主要認(rèn)為其不增加術(shù)后并發(fā)癥的發(fā)生率,同時(shí)也不會(huì)影響遠(yuǎn)期療效。但新輔助化療對(duì)腔鏡乳腺癌改良根治加假體植入術(shù)的并發(fā)癥和療效是否有明顯影響,目前文獻(xiàn)報(bào)道尚少。因此,本課題擬采用回顧性研究及前瞻性隨機(jī)對(duì)照研究的方法研究新輔助化療對(duì)腔鏡乳腺癌改良根治加假體植入乳房重建術(shù)的手術(shù)并發(fā)癥及療效的影響,為臨床乳腺癌腔鏡手術(shù)的規(guī)范化治療提供依據(jù)。研究方法和主要結(jié)果1.新輔助化療對(duì)腔鏡輔助乳腺癌手術(shù)后并發(fā)癥及療效的影響的回顧性研究方法:收集從2007年到2010年第三軍醫(yī)大學(xué)西南醫(yī)院乳腺中心總共183例確診并實(shí)施腔鏡輔助手術(shù)治療的乳腺癌患者的詳細(xì)基本資料,根據(jù)術(shù)前是否進(jìn)行新輔助化療將其分成兩組,其中對(duì)照組共85例,經(jīng)確診后首先給予腔鏡輔助手術(shù)治療,術(shù)后給予輔助化療。而剩余98例為新輔助化療組,首先給予2-4個(gè)周期的新輔助化療,隨后實(shí)施腔鏡輔助手術(shù)。對(duì)比兩組手術(shù)情況、術(shù)后并發(fā)癥和遠(yuǎn)期療效。結(jié)果:(1)nct組與對(duì)照組在手術(shù)時(shí)間(213.0±36.0vs215.1±38.5,p=0.704)、出血量(79.0±24.3vs74.1±20.0,p=0.144)、引流量(274.3±92.4vs283.7±80.1,p=0.469)方面差異均無(wú)統(tǒng)計(jì)學(xué)意義。(2)兩組在術(shù)后感染(3/98vs5/85,p=0.475)、乳頭或皮瓣壞死(6/98vs5/85,p=0.946)以及上肢水腫發(fā)生率(8/98vs12/85,p=0.291)方面亦無(wú)統(tǒng)計(jì)學(xué)差異。(3)隨訪至2015年3月31日(9~92個(gè)月),其中中位隨訪時(shí)間為66個(gè)月,兩組患者局部復(fù)發(fā)率(2/98vs2/85,p=1.000)、遠(yuǎn)處轉(zhuǎn)移率(12/98vs9/85,p=0.726)及死亡率(6/98vs4/85,p=0.925)之間無(wú)明顯差異。2.新輔助化療對(duì)乳腺癌腔鏡改良根治加假體植入乳房重建術(shù)后并發(fā)癥和療效影響的前瞻性隨機(jī)對(duì)照研究方法:納入自2013年1月1日起在西南醫(yī)院乳腺中心住院并實(shí)施腔鏡改良根治加假體植入乳房重建術(shù)治療病人共110例。病人入組后隨機(jī)分成兩組,其中直接進(jìn)行腔鏡手術(shù)的為對(duì)照組,共53例,首先給予2-4個(gè)周期新輔助治療的為新輔助化療組,總共57例。比較兩組手術(shù)情況、術(shù)后美觀度、術(shù)后并發(fā)癥和遠(yuǎn)期療效。結(jié)果:(1)nct組與對(duì)照組在手術(shù)時(shí)間(204.8±70.1vs210.3±68.3,p=0.674)、出血量(77.7±71.9vs72.8±61.2,p=0.703)、引流量(263.5±67.6vs255.1±77.3,p=0.544)差異無(wú)統(tǒng)計(jì)學(xué)意義。(2)兩組在術(shù)后感染或積液(5/57vs6/53,p=0.656)、乳頭或皮瓣壞死(5/57vs5/53,p=0.904)以及上肢水腫發(fā)生率(7/57vs6/53,p=0.876)方面亦無(wú)統(tǒng)計(jì)學(xué)差異(3)兩組患者術(shù)后美觀度的差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),絕大部分都屬于優(yōu)良,但是nct組優(yōu)良率略高于對(duì)照組(64.7%vs61.23%)。(3)隨訪至2015年4月30日(2~27個(gè)月),中位隨訪時(shí)間為12個(gè)月,兩組皆無(wú)1例患者出現(xiàn)局部復(fù)發(fā),僅有2例發(fā)生遠(yuǎn)處轉(zhuǎn)移,兩組各1例。兩組均未有死亡病例。結(jié)論回顧性和前瞻性隨機(jī)對(duì)照研究皆說(shuō)明了新輔助化療不會(huì)增加腔鏡乳腺癌改良根治術(shù)后并發(fā)癥的發(fā)生率,乳腺癌患者在新輔助化療后進(jìn)行腔鏡手術(shù)加假體植入乳房重建是安全有效的。
[Abstract]:Breast cancer has been the highest incidence of malignant tumor in women in recent years, and the incidence of breast cancer has increased year by year. With the continuous development of comprehensive breast cancer treatment, the prognosis has been improved obviously. With the continuous development of endoscopic technology, more and more applications of breast cancer in breast surgery have been made. In contrast to the traditional modified radical mastectomy, the nipple areola and the skin were retained, and the subcutaneous glands and lymph nodes were excised by a small incision and compared with the conventional modified radical mastectomy. The advantage of this is not only to ensure the same effect, but also to make a better appearance after the first phase of the prosthesis, to a great extent, to relieve the psychological drop of the patient and to have better quality of life. As an important part of the comprehensive treatment of breast cancer, neoadjuvant chemotherapy is a heavy pre operation of breast cancer patients. Many documents have reported that it has no obvious effect on the complications after traditional modified radical mastectomy, and it is mainly considered that it does not increase the incidence of postoperative complications and does not affect the long-term effect. However, new adjuvant chemotherapy has a significant impact on the combination of modified radical mastectomy and prosthesis implantation for endoscopic breast cancer. Therefore, we should use a retrospective study and prospective randomized controlled study to study the effect of neoadjuvant chemotherapy on the complications and curative effect of modified radical mastectomy and prosthesis implantation for breast cancer, and to provide the basis for the standardized treatment of endoscopic surgery for breast cancer. The research methods and main results are 1 A retrospective study of the effects of neoadjuvant chemotherapy on postoperative complications and efficacy of endoscopic assisted breast cancer surgery: a total of 183 cases of breast cancer in the breast center of Southwest Hospital of Third Military Medical University from 2007 to 2010 were collected and the detailed basic information of breast cancer patients treated by endoscopic assisted surgery was carried out according to whether neoadjuvant chemotherapy was performed before the operation. The control group was divided into two groups, of which 85 cases in the control group were first given endoscopic assisted surgery and adjuvant chemotherapy after operation. The remaining 98 cases were neoadjuvant chemotherapy group, first given 2-4 cycles of neoadjuvant chemotherapy, and then performed endoscopic assisted surgery. Compared the two groups of operations, postoperative complications and long-term effect. Results: (1) NCT group The operation time (213 + 36.0vs215.1 + 38.5, p=0.704), bleeding volume (79 + 24.3vs74.1 + 20, p=0.144), flow rate (274.3 + 92.4vs283.7 + 80.1, p=0.469) were not statistically significant. (2) two groups were infected (3/98vs5/85, p=0.475), nipple or flap necrosis (6/98vs5/85, p=0.946) and the incidence of upper limb edema (8/98) two There was no statistical difference in vs12/85, p=0.291). (3) follow up to March 31, 2015 (9~92 months), of which the median follow-up time was 66 months, the local recurrence rate (2/98vs2/85, p=1.000) in the two groups, the distant metastasis rate (12/98vs9/85, p=0.726) and the mortality (6/ 98vs4/85, p=0.925) were not significantly different from the.2. neoadjuvant chemotherapy to breast cancer endoscopy. A prospective randomized controlled study of the complications and effects of breast prosthesis implantation after breast reconstruction: a total of 110 patients were hospitalized in the breast center of Southwest Hospital since January 1, 2013 and treated by endoscopic modified radical mastectomy and prosthesis implantation. The patients were randomly divided into two groups, including direct cavity. A total of 53 cases in the control group were given a total of 53 cases. First, the new adjuvant chemotherapy group was given 2-4 cycles, a total of 57 cases. The two groups of operations, postoperative aesthetics, postoperative complications and long-term effect were compared. (1) the operation time (204.8 + 70.1vs210.3 + 68.3, p=0.674), and the amount of bleeding (77.7 + 71.9vs72.8 + 61.2, p=0.70) in the group and the control group. 3) there was no significant difference in the flow rate (263.5 + 67.6vs255.1 + 77.3, p=0.544). (2) there was no significant difference in postoperative infection or effusion (5/57vs6/53, p=0.656), papilla or flap necrosis (5/57vs5/53, p=0.904) and the incidence of upper limb edema (7/57vs6/53, p=0.876) in the two groups (3) there was no statistical difference between the two groups (P). 0.05) most of them were excellent, but the good rate of NCT group was slightly higher than that of the control group (64.7%vs61.23%). (3) follow up to April 30, 2015 (2~27 months), the median follow-up time was 12 months. The two groups had no 1 cases with local recurrence, only 2 cases had distant metastasis and two groups were 1. None of the two groups were dead. Conclusions retrospective and prospective. The randomized controlled study shows that neoadjuvant chemotherapy does not increase the incidence of complications after modified radical mastectomy for endoscopic breast cancer. It is safe and effective for breast cancer patients to undergo endoscopic surgery and prosthetic reconstruction after neoadjuvant chemotherapy.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R737.9

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7 劉洪濤;進(jìn)展期胃癌綜合治療中FOLFOX7新輔助化療的作用[D];第二軍醫(yī)大學(xué);2007年

8 彭忠民;Ⅲ期非小細(xì)胞肺癌骨髓微轉(zhuǎn)移與新輔助化療的關(guān)系探討[D];山東大學(xué);2004年

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10 陳金元;FLEP新輔助化療對(duì)胃癌患者免疫功能影響[D];南方醫(yī)科大學(xué);2014年

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