| Objective:To pay a return visit to the living conditions of the patients with early-stage breast cancer who suffered from operations in our hospital,and analyse the data by statistics,preliminary discussion wheather the application of sentinel lymph node biopsy in patients with breast cancer instead of axillary lymph node dissection is safe,and providing clinical basis for patients with early breast cancer underwent sentinel lymph node biopsy.Methods:1.Screening cases:Collecting and selecting the patients with early-stage breast cancer underwent operations from June 2012 to June 2013 in Affiliated Hospital of Chengde Medical University.A total of 115 patients was enrolled.The criteria which the patients must be satisfied were as follows:Female patients who underwent primary breast cancer surgery were successfully treated with axillary sentinel lymph node biopsy;the patients who had skip metastasis in their axillary lymph nodes were excluded;there were no enlarged and suspicious positive axillary lymph nodes in the preoperative examination and auxiliary examination;no neoadjuvant therapy was performed before operation;they all underwent total mastectomy;the patients who underwent breast concerving surgery were exluded.All patients who participated in the study signed informed consent.There was a complete follow-up record after operation.2.Observation indicators:Patients who underwent the operations in our hospital and satisfied the criteria were followed up by outpatient visits and telephone follow-up.We could get the results of whether the patients had local recurrence and distant metastasisthe of review.Meanwhile,to obtain the patients' postoperative survival data.The follow-up contents included thepatients' symptoms,signs and auxiliary examinations which included tumor markers(CEA,CA153,CA125),chest lateral radiographs,hepatobiliary and pancreatic splenic ultrasonography,breast ultrasound and mammography,neck and supraclavicular lymph nodes,according to the disease on the selective application of some patients with CT,MRI,isotopic bone scan and so on.There were three indexes to evaluate the survival status of patients,including pain,swelling and activity limitation.Local recurrence was confirmed by pathological results after clinical examination and auxiliary examination.Distant metastasis was confirmed by clinical examination and auxiliary examination,such as nuclear magnetic resonance,CT,isotope bone scan and so on.3.Grouping methods: According to the surgical procedure of each patient's armpit,they were divided into two groups.One group was the experimental group,that was the sentinel lymph node biopsy group,which was armpit sentinel lymph node biopsy only.The other group was the control group,namely,axillary lymph node dissection group,which was axillary lymph node dissection on the basis of sentinel lymph node biopsy.Two groups of patients were followed up and their survival data were collected.The postoperative complications and quality of life were compared between the two groups,and the local recurrence rate,distant metastasis rate and survival rate were reviewed.The results of the visit were analyzed statistically to see if there was a statistically significant difference.4.Statistical methods: We used the software of SPSS19.0 for statistical analysis of the data,with P <0.05 for the difference was statistically significant.The results of the measurement were given by normal test and homogeneity of variance,and the results of measurement data were expressed as mean + standard deviation(+ s).Count data between the groups were using chi-square test.Measurement data between the two groups were using t test.Calculating DFS and RFS were using Kaplan-Meier method.Results:1.The results of clinical diagnosis of SLNB and results of return visit: Atotal of 366 sentinel lymph nodes was cleared from 115 patients,with an average of 3.18 pieces.Follow-up of 115 patients,the experimental group of48 patients was 2 patients lost,the loss rate was 4.2%(2/48),the control group of 67 patients was 7 lost,the loss rate was 10.4%(7/67).There was no significant difference between the two groups(?2 = 0.783,P = 0.376).The patients in the SLNB group had 13.0%(6/46)of upper limb pain,4.3%(2/46)was swollen,15.2%(7/46)was limited mobility.The patients in the ALND group had 51.7%(31/60)of upper limb pain,33.3%(20/60)in swollen patients,38.3%(23/60)in patients with limited activity.There was statistically significant difference between SLNB group and ALND group in postoperative complications such as pain,swelling and activity limitation(P <0.05).There were 46 cases of follow-up cases including 1 case of local recurrence and 1case of distant metastasis in the experimental group,and 60 cases of follow-up cases including 3 cases of local recurrence and 1 case of distant metastasis in the control group.There were no deaths both in the control group and experimental group.According to the results of the visit,the survival curve was drawn with the follow-up month as the abscissa,the survival rate was the ordinate and the two curves were the same,and there was no significant deviation.There was no significant difference between the two groups(?2 =1.856,P = 0.173).2.The results of the statistical analysis of the results:In the 3 years follow-ups period,we payed a return visit to the living conditions of the early-stage breast cancer patients who suffered the operation and collected the data.We found that there were significant differences in the post operative complications,including edema,pain,limited mobility,and quality of life of the two group(P<0.05),and the experimental group was significantly better in these aspects better than the control group.However,there was no significant difference between the two groups in the local recurrence rate and distant metastasis rate(P>0.05),that is,there was no statistically significant difference in the survival rate between the two groups.Indicating that the two groups of patients with which surgeryfor its 3-year survival time was not affected.Conclusion:1.If the rapid frozen pathology confirmed sentinel lymph nodes were negative,then the only operation of sentinel lymph node biopsy at the armpit was safe and reliable,did not have to continue axillary lymph node dissection,to provide a certain basis for the clinical development of sentinel lymph node biopsy.2.Sentinel lymph node biopsy alone could significantly reduce the postoperative complications and improve the quality of life of patients after surgery,and there was no significant impact on local recurrence rate and distant metastasis rate of this surgical approach to this part of the patients with breast cancer.3.SLNB,its theoretical knowledge was easy to understand and operate,auxiliary equipment and drug clinical were easy to get.It was worth in the majority of clinical promotion. |
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