Effect of improved radical surgery for preserving nipple and areola combined with prosthesis implantation on early breast cancer patients

doi:10.3877/cma.j.issn.1674-0793.2020.05.005

Abstract

Abstract:

Objective

To investigate the effect of modified radical operation for preserving nipple and areola combined with prosthesis implantation on coping style and aesthetic effect of patients with early breast cancer.

Methods

A total of one hundred and forty early breast cancer patients treated in Chang’an Hospital from March 2017 to March 2019 were selected and divided into study group and control group, with 70 cases in each group. The study group adopted modified radical operation for preserving nipple and areola combined with prosthesis implantation, while the control group underwent modified radical mastectomy for breast cancer. The operation time, number of lymph node dissection, postoperative drainage and hospitalization time, complications (subcutaneous emphysema, infection, skin necrosis, subcutaneous effusion, upper limb edema), aesthetic effect, immune function (CD3⁺, CD4⁺, CD4⁺/CD8⁺) and coping style before and after operation were compared between the two groups.

Results

The postoperative drainage volume of the study group was less than that of the control group, and the hospital stay was shorter than that of the control group (t=13.584, 8.423, P<0.001, <0.001). CD3⁺, CD4⁺, and CD4⁺/CD8⁺ of the study group were higher than those of the control group one day after operation (t=6.612, 7.057, 5.170, all P<0.001). One month after surgery, the scores of self-reliance, palliative care, fatalism and escape in the study group were lower than those in the control group, while the scores of emotional catharsis, support seeking, optimism and face-to-face in the study group were higher than those in the control group (t=10.821, 11.010, 7.854, 5.952, 8.563, 9.657, 9.223, 11.596, all P<0.001). The incidence of complications in the study group (5.72%) was lower than that in the control group (20.00%) (χ²=6.375, P=0.012). The excellent rate of aesthetic effect in the study group (92.86%) was higher than that in the control group (81.43%) (χ²=4.080, P=0.043).

Conclusion

Nipple and areola-preserving combined radical mastectomy combined with prosthesis implantation can reduce complications, improve coping styles and aesthetic effects, and have less impact on immune function.

Key words: Breast neoplasms, Mastectomy, modified radical, Prosthesis implantation, Coping Style

Zhengqiang Wang, Fengbo Han. Effect of improved radical surgery for preserving nipple and areola combined with prosthesis implantation on early breast cancer patients[J]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(05): 341-345.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2020.05.005

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2020/V14/I05/341

Figures/Tables 5

References 21

[1]	张展强, 袁凯涛, 张德元, 等. 前哨淋巴结阳性乳腺癌非前哨淋巴结转移的情况分析[J/CD]. 中华普通外科学文献(电子版), 2019, 13(1): 16-20.
[2]	于红艳, 曹葆强, 张培松, 等. FTS护理对乳腺癌改良根治术患者负性情绪及术后康复效果的影响[J]. 武警医学, 2019, 30(1): 31-34.
[3]	He S, Yin J, Robb GL, et al. Considering the optimal timing of breast reconstruction with abdominal flaps with adjuvant irradiation in 370 consecutive pedicled transverse rectus abdominis myocutaneous flap and free deep inferior epigastric perforator flap performed in a Chinese oncology center: is there a significant difference between immediate and delayed[J]. Ann Plast Surg, 2017, 78(6): 633-640.
[4]	张敏, 盛华丽. 改良根治术治疗乳腺癌的围术期护理[J]. 实用临床医药杂志, 2017, 21(16): 85-87.
[5]	曹勇, 罗杰, 周鑫, 等. 肿瘤整形技术在早期乳腺癌保乳手术中的临床应用[J]. 中国普通外科杂志, 2017, 26(5): 607-613.
[6]	柴丽君, 张学慧. 前锯肌肌瓣在乳腺癌改良根治术后即刻乳房再造中的应用[J]. 中国修复重建外科杂志, 2017, 31(9): 1098-1101.
[7]	谢幸, 苟文丽. 妇产科学[M]. 8版. 北京: 人民卫生出版社, 2013: 255-256.
[8]	李展绒, 张永梅. 情志护理对结直肠癌手术患者围手术期应对方式及心境状态的影响[J]. 河北医药, 2016, 38(7): 1105-1107.
[9]	刘梦友, 金功圣, 陈晨, 等. 保留乳头乳晕乳腺癌改良根治术后即刻扩展型背阔肌乳房再造术的临床应用[J]. 中国普通外科杂志, 2018, 27(5): 601-607.
[10]	贾新建, 雷海. 保留胸前神经及肋间臂神经的乳腺癌手术方式的疗效及对术后生活质量的影响[J/CD]. 中华普通外科学文献(电子版), 2018, 12(3): 208-211.
[11]	Chen K, Liu J, Zhu L, et al. Comparative effectiveness study of breast-conserving surgery and mastectomy in the general population: a NCDB analysis[J]. Oncotarget, 2015, 6(37): 40127-40140.
[12]	李萌, 尚进, 杨波, 等. 保留乳头乳晕的乳腺癌改良根治术对患者细胞免疫功能及甲状腺激素水平的影响[J]. 解放军医药杂志, 2018, 30(10): 34-38.
[13]	Sim N, Soh S, Ang CH, et al. Breast reconstruction rate and profile in a Singapore patient population: a national university hospital experience[J]. Singapore Med J, 2017, 59(6): 300-304.
[14]	王萌萌, 王京, 华建芬, 等. 保留乳头乳晕的乳腺癌改良根治术联合Ⅰ期假体植入与传统乳腺癌改良根治术的临床疗效对比[J]. 中国妇幼保健, 2017, 32(23): 6040-6043.
[15]	鲁海燕, 张喜平. 香菇多糖对新辅助化疗后乳腺癌患者免疫功能及淋巴细胞的影响[J].安徽医药, 2018, 22(12): 2427-2430.
[16]	Feng HX, Cheng Y, Zhu W, et al. T-lymphocyte subsets as a predictive biomarker for stroke-associated pneumonia[J]. Am J Transl Res, 2018, 10(12): 4367-4375.
[17]	孙萍, 梁栋. 保留乳头乳晕改良根治术联合假体置入术对早中期乳腺癌患者免疫功能及负性情绪的影响[J]. 中国临床医生杂志, 2018, 46(4): 453-456.
[18]	徐琳, 杨金旭. 微信式延续护理对乳腺癌术后功能锻炼依从性和生活质量影响[J]. 实用医学杂志, 2017, 33(1): 143-146.
[19]	王亚楠, 李平, 叶苓, 等. 互动达标理论在乳腺癌患者术后康复护理中的应用研究[J].重庆医学, 2017, 46(20): 2873-2875.
[20]	石晶晶, 王宗宝. 改良根治术结合即刻乳房再造术对乳腺癌患者预后的影响[J]. 华南国防医学杂志, 2018, 32(11): 772-775.
[21]	陈淑如, 吴楚成, 颜宁, 等. 保留乳头乳晕改良根治术联合假体置入术治疗早期乳腺癌效果观察[J]. 山东医药, 2015, 55(2): 91-93.

临床资料		研究组	对照组	统计值	P值
例数		70	70	?	?
年龄（岁）		23~60(41.55±8.36)	25~60(42.48±7.57)	t=0.689	0.491
病程（d）		15~448(231.48±87.01)	15~450(233.17±85.38)	t=0.116	0.908
肿瘤直径（cm）		0.6~3.0(1.78±0.34)	0.5~3.0(1.84±0.30)	t=1.107	0.270
临床分期[例(%)]		?	?	χ²<0.001	1.000
?	0期	25(35.71)	26(37.14)	?	?
?	Ⅰ期	28(40.00)	29(41.43)	?	?
?	Ⅱa期	17(24.29)	15(21.43)	?	?
病变位置[例(%)]		?	?	χ²=0.386	0.824
?	右侧	29(41.43)	32(45.71)	?	?
?	左侧	31(44.29)	30(42.86)	?	?
?	双侧	10(14.28)	8(11.43)	?	?
病理类型[例(%)]		?	?	χ²=0.324	0.851
?	黏液腺癌	6(8.57)	8(11.43)	?	?
?	浸润性导管癌	45(64.29)	44(62.86)	?	?
?	导管内癌	19(27.14)	18(25.71)	?	?

临床资料		研究组	对照组	统计值	P值
例数		70	70	?	?
年龄（岁）		23~60(41.55±8.36)	25~60(42.48±7.57)	t=0.689	0.491
病程（d）		15~448(231.48±87.01)	15~450(233.17±85.38)	t=0.116	0.908
肿瘤直径（cm）		0.6~3.0(1.78±0.34)	0.5~3.0(1.84±0.30)	t=1.107	0.270
临床分期[例(%)]		?	?	χ²<0.001	1.000
?	0期	25(35.71)	26(37.14)	?	?
?	Ⅰ期	28(40.00)	29(41.43)	?	?
?	Ⅱa期	17(24.29)	15(21.43)	?	?
病变位置[例(%)]		?	?	χ²=0.386	0.824
?	右侧	29(41.43)	32(45.71)	?	?
?	左侧	31(44.29)	30(42.86)	?	?
?	双侧	10(14.28)	8(11.43)	?	?
病理类型[例(%)]		?	?	χ²=0.324	0.851
?	黏液腺癌	6(8.57)	8(11.43)	?	?
?	浸润性导管癌	45(64.29)	44(62.86)	?	?
?	导管内癌	19(27.14)	18(25.71)	?	?

组别	例数	手术时间（min）	淋巴结清扫数目（个）	术后引流量（ml）	住院时间（d）
研究组	70	110.08±17.15	16.79±3.38	151.51±37.50	10.08±2.02
对照组	70	108.34±16.56	16.30±3.13	240.64±40.09	14.07±3.41
t值	?	0.611	0.889	13.584	8.423
P值	?	0.542	0.375	<0.001	<0.001

组别	例数	手术时间（min）	淋巴结清扫数目（个）	术后引流量（ml）	住院时间（d）
研究组	70	110.08±17.15	16.79±3.38	151.51±37.50	10.08±2.02
对照组	70	108.34±16.56	16.30±3.13	240.64±40.09	14.07±3.41
t值	?	0.611	0.889	13.584	8.423
P值	?	0.542	0.375	<0.001	<0.001

组别	例数	CD3⁺（%）		CD4⁺（%）		CD4⁺/CD8⁺
组别	例数	术前	术后1 d	术前	术后1 d	术前	术后1 d
研究组	70	52.04±5.16	48.39±4.91^a	30.93±3.64	27.68±3.81^a	1.89±0.40	1.44±0.31^a
对照组	70	51.67±5.69	43.18±4.40^a	31.18±3.23	23.27±3.58^a	1.92±0.38	1.19±0.26^a
t值	?	0.403	6.612	0.429	7.057	0.455	5.170
P值	?	0.687	<0.001	0.668	<0.001	0.649	<0.001û

Please choose a citation manager

Content to export