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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 283 -287. doi: 10.3877/cma.j.issn.1674-0807.2021.05.003

论著

新辅助化疗对乳腺癌改良根治术后并发症及凝血功能的影响
邓玉燕1, 庞永慧2,†(), 莫钦国2, 谭虹虹2, 茅传兰2, 陈菲菲2   
  1. 1. 530003　南宁，广西壮族自治区妇幼保健院护理部
    2. 530021　南宁，广西医科大学附属肿瘤医院乳腺外科
  • 收稿日期:2020-02-20 出版日期:2021-10-01
  • 通信作者: 庞永慧

Effect of neoadjuvant chemotherapy on complications and coagulation function after modified radical mastectomy

Yuyan Deng1, Yonghui Pang2,†(), Qinguo Mo2, Honghong Tan2, Chuanlan Mao2, Feifei Chen2   

  1. 1. Department of Nursing, Maternity and Child Healthcare Hospital of Guangxi Zhuang Autonomous Region, Nanning 530003, China
    2. Department of Breast Surgery, Cancer Hospital of Guangxi Medical University, Nanning 530021, China
  • Received:2020-02-20 Published:2021-10-01
  • Corresponding author: Yonghui Pang
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引用本文：

邓玉燕, 庞永慧, 莫钦国, 谭虹虹, 茅传兰, 陈菲菲. 新辅助化疗对乳腺癌改良根治术后并发症及凝血功能的影响[J]. 中华乳腺病杂志(电子版), 2021, 15(05): 283-287.

Yuyan Deng, Yonghui Pang, Qinguo Mo, Honghong Tan, Chuanlan Mao, Feifei Chen. Effect of neoadjuvant chemotherapy on complications and coagulation function after modified radical mastectomy[J]. Chinese Journal of Breast Disease(Electronic Edition), 2021, 15(05): 283-287.

目的

探讨新辅助化疗是否影响乳腺癌患者改良根治术后的并发症和凝血功能。

方法

回顾性分析2016年9月至2019年12月在广西医科大学附属肿瘤医院乳腺中心行改良根治术的110例乳腺癌患者临床资料，其中53例接受8周期多柔比星+环磷酰胺序贯多西他赛(AC-T)新辅助化疗为新辅助化疗组(NCT组)，57例未接受新辅助化疗患者为对照组。采用两独立样本t检验比较2组患者手术情况(手术时间、术中出血量和术后引流量)，采用χ2检验或Fisher确切概率检验比较2组患者的淋巴结转移率和术后并发症发生率(皮下积液、皮瓣坏死、患肢水肿、感染和静脉血栓)，采用重复测量方差分析比较术前1 d、术后1 d和术后7 d患者的凝血功能相关指标[血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)及D-二聚体]的差异。

结果

(1)2组患者间手术时间、术中出血量、总引流量和淋巴结转移率比较，差异均无统计学意义(t＝0.164，P＝0.870；t＝-0.584，P＝0.560；t＝-0.340，P＝0.734；χ2＝0.182，P＝0.669)；(2)2组患者间术后皮下积液、皮瓣坏死、患肢水肿、感染和静脉血栓发生率比较，差异均无统计学意义(χ2＝0.036，P＝0.849；P＝1.000；χ2＝0.182，P＝0.670；P＝1.000；P＝0.230)；(3)PLT、PT、APTT、TT、FIB和D-二聚体组内变异中的时间因素差异有统计学意义(F＝8.826，P<0.001；F＝3.210，P＝0.044；F＝3.491，P＝0.032；F＝24.811，P<0.001；F＝72.847，P<0.001；F＝267.238，P<0.001)；APTT、FIB和D-二聚体组间变异中的组别因素比较，差异有统计学意义(F＝5.854，P＝0.017；F＝4.616，P＝0.034；F＝7.761，P＝0.006)；而所有凝血功能指标无交互效应(F＝2.045，P＝0.134；F＝0.998，P＝0.372；F＝1.340，P＝0.264；F＝0.302，P＝0.740；F＝0.305，P＝0.737；F＝1.703，P＝0.187)。

结论

8个周期AC-T新辅助化疗方案并不会增加乳腺癌改良根治术后并发症的发生率，但可使APTT缩短，FIB及D-二聚体显著升高，导致乳腺癌患者术后血液高凝状态的产生。

关键词: 乳腺肿瘤, 药物疗法，联合, 手术后并发症
Objective

To investigate the effect of neoadjuvant chemotherapy (NCT) on the complications and coagulation function after modified radical mastectomy.

Methods

A retrospective analysis was performed on the clinical data of 110 patients who underwent modified radical mastectomy in the Department of Breast Surgery, Cancer Hospital of Guangxi Medical University from September 2016 to December 2019. Fifty-three patients received 8 cycles of NCT (doxorubicin and cyclophosphamide followed by docetaxel, AC-T) (NCT group) and 57 patients underwent modified radical mastectomy but received no NCT (control group). The operation parameters (operation time, intraoperative hemorrhage and total drainage volume) were compared between two groups by t-test of two independent samples. The incidences of lymph node metastasis postoperative complications (subcutaneous hydrops, skin flap necrosis, edema of affected limb, infection and venous thrombosis) were compared between two groups by χ2 test or Fisher exact probability test. The related parameters of coagulation function[platelet count (PLT), prothrombin time (PT), activated partial thrombin time (APTT), thrombin time (TT), fibrinogen (FIB) and D-dimer]were compared at different time points (1 day before operation, 1 day and 7 days after operation) by ANOVA analysis of repeated measurements.

Results

(1)There was no significant difference in operation time, intraoperative hemorrhage, total drainage and lymph node metastasis rate between two groups (t=0.164, P=0.870; t=-0.584, P=0.560; t=-0.340, P=0.734; χ2=0.182, P=0.669). (2)There was no significant difference in the incidences of postoperative subcutaneous hydrops, flap necrosis, limb edema, infection and venous thrombosis between two groups(χ2=0.036, P=0.849; P=1.000; χ2=0.182, P=0.670; P=1.000; P=0.230). (3) PLT, PT, APTT, TT, FIB and D-dimer showed a significant difference between different time points (F=8.826, P<0.001; F=3.210, P=0.044; F=3.491, P=0.032; F=24.811, P<0.001; F=72.847, P<0.001; F=267.238, P<0.001). APTT, FIB and D-dimer showed a significant difference between groups (F=5.854, P=0.017; F=4.616, P=0.034; F=7.761, P=0.006). There was no significant interaction between time factors and grouping factor for all parameters (F=2.045, P=0.134; F=0.998, P=0.372; F=1.340, P=0.264; F=0.302, P=0.740; F=0.305, P=0.737; F=1.703, P=0.187).

Conclusion

Eight cycles of NCT (AC-T) do not increase the incidence of complications after modified radical mastectomy, but they can shorten APTT and increase FIB and D-dimer levels in the blood, leading to postoperative hypercoagulability in the blood of breast cancer patients.

Key words: Breast neoplasms, Drug therapy, Combination, Postoperative complications
表1 新辅助化疗组与对照组乳腺癌患者一般资料比较
组别 例数 年龄(岁，±s) BMI(kg/m2，±s) HER-2表达[例(%)] TNM分期[例(%)] 病理类型[例(%)]
阳性 阴性 Ⅱ期 Ⅲ期 IDC ILC
NCT组 53 47.7±8.3 22.4±2.0 18(34.0) 35(66.0) 25(47.2) 28(52.8) 48(90.6) 5(9.4)
对照组 57 49.6±8.8 22.7±2.1 16(28.1) 41(71.9) 33(57.9) 24(42.1) 50(87.7) 7(12.3)
检验值   t＝-1.120 t＝-0.669 χ2＝0.446 χ2＝1.267 χ2＝0.229
P值   0.265 0.505 0.504 0.260 0.632
表2 新辅助化疗组与对照组乳腺癌患者的手术情况比较
组别 例数 手术时间(min，±s) 术中出血量(ml，±s) 总引流量(ml，±s) 腋窝淋巴结转移[例(%)]
≤3枚 >3枚
新辅助化疗组 53 141.7±39.8 56.7±22.7 336.2±115.4 44(83.0) 9(17.0)
对照组 57 140.6±32.0 58.8±22.9 343.2±106.6 49(86.0) 8(14.0)
检验值   t＝0.164 t＝-0.584 t＝-0.340 χ2＝0.182
P值   0.870 0.560 0.734 0.669
表3 新辅助化疗组与对照组乳腺癌患者的术后并发症比较[例(%)]
组别 例数 皮下积液 皮瓣坏死 患肢水肿 感染 静脉血栓
新辅助化疗组 53 5(9.4) 0(0) 6(11.3) 2(3.8) 2(3.8)
对照组 57 6(10.5) 1(1.7) 8(14.0) 2(3.5) 0(0)
χ2值   0.036   0.182    
P值   0.849 1.000a 0.670 1.000a 0.230a
表4 新辅助化疗组与对照组乳腺癌患者不同时间点凝血功能相关指标比较(±s)
组别 例数 PLT(×109/L) PT(s) APTT(s)
术前1 d 术后1 d 术后7 d 术前1 d 术后1 d 术后7 d 术前1 d 术后1 d 术后7 d
NCT组 53 244.64±77.18 236.43±80.76 244.96±63.51 11.14±0.95c 11.63±1.07a 11.27±0.92b 26.33±4.85c 26.65±4.57 28.12±4.15a
对照组 57 265.65±63.02 239.45±56.71a 261.43±51.19b 11.56±1.19 11.69±1.36 11.57±1.19 28.84±4.45 27.63±4.53 29.04±5.09
时间效应                    
  F值   8.826 3.210 3.491
  P值   <0.001 0.044 0.032
组间效应                    
  F值   1.520 2.880 5.854
  P值   0.220 0.093 0.017
交互效应                    
  F值   2.045 0.998 1.340
  P值   0.134 0.372 0.264
组别 例数 TT(s) FIB(g/L) D-二聚体(mg/L)
术前1 d 术后1 d 术后7 d 术前1 d 术后1 d 术后7 d 术前1 d 术后1 d 术后7 d
NCT组 53 16.59±1.15 15.81±1.56a 15.33±1.20a、b 3.48±0.55c 3.62±1.08 4.61±1.00a、b 0.42±0.25 1.42±0.71a 1.80±0.71a、b
对照组 57 16.50±1.35 15.84±1.26a 15.48±1.41a 3.25±0.53 3.42±0.92 4.26±0.89a、b 0.34±0.25 1.19±0.58a 1.54±0.84a、b
时间效应                    
  F值   24.811 72.847 267.238
  P值   <0.001 <0.001 <0.001
组间效应                    
  F值   0.034 4.616 7.761
  P值   0.854 0.034 0.006
交互效应                    
  F值   0.302 0.305 1.703
  P值   0.740 0.737 0.187
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