摘要
目的观察乳腺癌术后辅助局部灌注化疗对患者预后的影响,探讨手术过程中在术区置入化疗泵的操作方法及注意事项。方法收集Ⅱ-Ⅲ期乳腺癌患者102例,其中23例(对照组)行单纯象限切除加腋窝淋巴结清扫术或乳腺癌改良根治术,79例(置泵组)除接受手术以外,另在术中经胸外侧动脉或肩胛下动脉至腋动脉插入化疗泵导管,尾端经皮下引出,接化疗泵,并固定于皮肤表面,备术后局部辅助化疗使用。术后1周给予肝素冲管1次,防止泵管堵塞。手术后10～14d经泵体注入氟尿嘧啶(5-FU),0.25g/次,共4次,总量1.0g,最后1次局部灌注后拔除泵管,拆除泵体,腋窝适当加压以减少局部血肿;术后常规予放射治疗、全身化疗和内分泌治疗。术后随访18～48个月,观察患者的局部复发情况。结果对照组手术时间为94～137(103±14)min,置泵组手术时间为105～158(126±17)min,局部灌注化疗术中置管时间15～60(25±3)min。置泵组中,5例(6.3%)泵管穿出皮肤处渗液及附近皮肤积液,3例(3.8%)拔管后局部出现小血肿,但自行吸收,不影响上肢活动。随访期间,置泵组患者无局部复发,对照组2例出现局部复发。结论乳腺癌术后辅助局部灌注化疗可降低局部复发率;术中放置化疗泵增加了手术时间,但不会造成严重并发症。
Objective To observe the effects of postoperative adjuvant local chemotherapy on the prognosis of the patients with breart cancer,and explore the skill of intraoperative placement of a catheter for postoperative chemotherapy duning the operation.Methods Of 102 patients with breast cancer in stage Ⅱ to Ⅲ,23 were assigned to control group and 79 to catheter and pump-placement group.Quadrantectomy plus axillary lymph node dissection or modified radical mastectomy was performed in both groups,followed by the insertion of a catheter for pumping of chemotherapeutic drug in pump-placement group.The catheter was inserted into axillary artery through the lateral thoracic artery or subscapular artery,connecting with a chemotherapy pump for instillation of chemotherapeutic drug and it was fixed on the skin for local adjuvant chemotherapy thereafter.The catheter was washed with heparin once a week to prevent occlusion.10-14 days after surgery,patients in pump-placement group underwent local chemotherapy with 5-FU at a dose of 0.25g once for 4 times up to a total dose of 1.0g.Routine systematic chemotherapy,radiation and endocrine therapy were given to both groups.Local recurrence was examined during an 18-to 48-month follow-up.Results It took 94-137（103±14） minutes in control group to perform surgery alone,while it took 105-158（126±17） minutes in pump-placement group to perform surgery plus chemotherapy pump placement,in which insertion of the catheter took 15-60（25±3） minutes.In pump-placement group,exudation in or around the skin at the exit of the catheter occurred in 5 cases（6.3%）,small hematoma in axillary fossa less than 3cm in diameter occurred in 3 cases（3.8%）,but there was no limitation of upper extremity movement.During follow-up,local recurrence occurred in 2 patients in control group,while no local recurrence in pump-placement group.Conclusions Postoperative local intensified adjuvant chemotherapy may be beneficial in patients with breast cancer with a decrease in recurrence rate.The pl
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2011年第10期1098-1100,共3页
Medical Journal of Chinese People's Liberation Army
