乳腺癌术后胸壁复发病灶综合治疗的临床研究

目的　研究术前放射、化学、免疫和中医药等综合治疗对乳腺癌术后胸壁复发病人二次手术的影响和价值。方法　将6 7例患者随机分为两组。治疗组4 7例乳腺癌术后胸壁复发患者二次术前进行放疗加化疗加中医辨证治疗或化疗加局部免疫治疗加中医辨证治疗;对照组2 0例患者直接进行局部扩大切除术。术后标本分别距离肿瘤边缘1cm和2cm处进行病理检查,记录术后并发症及伤口愈合情况,进行统计学分析。结果　治疗组距离肿瘤边缘1cm和2cm处检出癌细胞情况分别为7例(15 % )和3例(6 % ) ,对照组分别为12例(6 0 % )和7例(35 % ) ,经统计学分析差异有统计学意义(P <0 .0 0 1,P <0 . 0 0 5 )。术后切口并发症治疗组13例(2 8% ) ,对照组12例(6 0 % ) ,差异有统计学意义(P <0 . 0 0 5 )。结论　乳腺癌术后胸壁复发病灶二次术前给予综合治疗可以缩小手术范围,减少切缘癌细胞残留率和术后并发症,提高局部控制率,对临床深入研究乳腺癌术后复发的防治具有重要意义。

Clinical study on synthetic treatment of chest wall recurrent focus after surgery for breast cancer

Objective To investigate the effect and value o f combined radiotherapy,chemotherapy,immunization therapy,traditional Chinese medi cine on cases of chest wall recurrent focus after second surgery for breast canc er.Methods Sixty-seven cases were randomly divided into two gr oups:forty-seven cases of the treated group received the combined treatment of radiotherapy,chemotherapy and traditional Chinese medicine,or combined chemother apy,local immunization and traditional Chinese medicine.Twenty cases of the cont rol group underwent directly local extensive excision.The samples excised from t he 1 cm and 2 cm borders of tumor tissue were examined.Postoperative complicatio n and wound healing were recorded,the data were statistically analyzed.R esults Cancer cells wee found at the edge of 1 cm and 2 cm near the tum or tissue.The treated groups showed positive in 7 cases (15%) and in 3 cases (6% ).The control groups showed positive in 12 cases (60%) and in 7 cases (35%),the above results showed significant statistic difference (P<0.001,P<0.005 ).The complication after operation occurred in 13 cases of treated group (28%),and in 12 cases of control group (60%),with a significant statistic diffe rence (P<0.005).Conclusion Before the second surgery of chest wall recurrent focus of breast cancer,the synthetic treatment could red uce surgical area,decrease the cancer cell residual rate and postoperative compl ication,improving local control rate.This study has significance to further clin ical investigation.