加速康复外科对乳腺癌改良根治术患者应激及炎症反应的影响

doi:10.11904/j.issn.1002-3070.2015.06.009

实用肿瘤学杂志 ›› 2015, Vol. 29 ›› Issue (6): 523-527.doi: 10.11904/j.issn.1002-3070.2015.06.009

加速康复外科对乳腺癌改良根治术患者应激及炎症反应的影响

余红敏¹, 罗海平², 毛哲玉¹

1.黄石市中心医院肿瘤外科(黄石 435000);
2.黄石市中心医院胃肠外科

收稿日期:2015-07-20 出版日期:2015-12-28 发布日期:2015-12-28
通讯作者: 罗海平,E-mail:Luohaiping87@163.com E-mail:Luohaiping87@163.com
作者简介:余红敏,女,(1988-),硕士,住院医师,从事乳腺肿瘤外科方面的研究

The influence of fast track surgery on stress and inflammatory response in breast cancer patient s treated with modified radical mastectomy

YU Hongmin¹, LUO Haiping², MAO Zheyu¹

1.Department of Surgical Oncology,Huang-Shi Hospital,Huangshi 435000,China;
2 Department of Gastrointestinal Surgery,Huang-shi Central Hospital

Received:2015-07-20 Online:2015-12-28 Published:2015-12-28

摘要/Abstract

摘要： 目的探讨快速康复外科对乳腺癌改良根治术患者术后应激及炎症反应的影响。方法将99例择期行乳腺癌改良根治术的患者随机分为快速康复外科组(FTS)和对照组,采用放射免疫法检测上述患者术前、术后12h、24h及48h血清肾素、血管紧张素Ⅱ、醛固酮、皮质醇、IL-6、IL-8和TNF-α的浓度,比较二组患者手术时间、术中出血量、住院天数、术后皮下积液、皮瓣坏死及上肢血肿发生率的差异。结果 FTS组及对照组术前及术后48h血清肾素、血管紧张素Ⅱ、醛固酮、皮质醇、IL-6、IL-8和TNF-α的浓度差异无统计学意义(P＞0.05)。FTS组术后12h及24h血清肾素、血管紧张素Ⅱ、醛固酮、皮质醇、IL-6、IL-8及TNF-α的浓度较对照组降低,差异具有统计学意义(P＜0.05)。术中出血量在FTS组及对照组分别为(156.98±17.09)mL和(158.57±16.92)mL,差异无统计学意义(P＞0.05)。上肢水肿、皮下积液及皮瓣坏死发生率在FTS组及对照组无差异(P＞0.05)。FST组及对照组的平均住院天数分别为(8.37±1.89)d和(10.37±2.05)d,差异具有统计学意义(P＜0.05)。结论快速康复外科可有效减轻乳腺癌改良根治术患者的应激及炎症反应,明显加速术后康复进程,在乳腺癌改良根治术中的应用是安全可行的。

关键词: 乳腺癌, 加速康复外科, 应激, 炎症

Abstract: Objective To investigate the influence of fast track surgery on stress and inflammatory response in breast cancer patients treated with modified radical mastectomy.Methods Ninety nine patients with breast cancer undergoing modified radical mastectomy were allocated randomly to fast track surgery group(46cases)and general group(53cases).The concentrations of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8,TNF-α of each group were measured before operation,12 hour,24hour and 48hour after operation by radioimmunoassay method.Operation time,operative blood loss and hospitalization days were analyzed between the two groups,simultaneously,the incidence of subcutaneous hydrops,flap necrosis and upper limb edema were also detected.Results The concentration of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-α were no significantly differences in two groups before operation and at 48 hours after surgery(P＞0.05).The concentrations of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-α of FTS group were significantly different between the preoperative and different time points(P＜0.05).The concentration of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-α of FTS group were lower than that of control group at the same time point(P＜0.05).The operative time was(158.32±22.47)mins in FTS group and(161.32±22.37)mins in control group,respectively,and there were no significant statistical differences(P＞0.05).The intraoperative blood loss in the FTS group(156.98±17.09)ml was not significantly less than that in the control group(158.57±16.92)ml(P=0.644).Hospitalization days were 8.37±1.89 and 10.37±2.05 in the FTS and the control group respectively,with significant difference.The incidence of upper limb edema,subcutaneous hydrops,flap necrosis in FTS group were not less than control group.Conclusion Fast track surgery could attenuate stress and inflammatory response during,and it is safe and effective in modified radical mastectomy.

Key words: Breast cancer, Fast track surgery, Stress response, Inflammatory response

中图分类号:

R737.9

余红敏, 罗海平, 毛哲玉. 加速康复外科对乳腺癌改良根治术患者应激及炎症反应的影响[J]. 实用肿瘤学杂志, 2015, 29(6): 523-527.

YU Hongmin, LUO Haiping, MAO Zheyu. The influence of fast track surgery on stress and inflammatory response in breast cancer patient s treated with modified radical mastectomy[J]. PRACTICAL ONCOLOGY JOURNAL, 2015, 29(6): 523-527.

参考文献

1 Deegan CA,Murray D,Doran P,et al.Anesthetic technique and the cytokine and matrix metalloproteinase response to primary breast cancer surgery[J].Reg Anesth Pain Med,2010,35(6):490-495.
2 Udelsman R,Holbrook NJ.Endocrine and molecular responses to surgical stress[J].Curr Probl Surg,1994,31(8):653-720.
3 Mertz BG,Kroman N,Williams H,et al.Fast-track surgery for breast cancer is possible[J].Dan Med J,2013,60(5):A4615.
4 Tsigos C,Chrousos GP.Hypothalamic-pituitary-adrenal axis,neuroendocrine factors and stress[J].J Psychosom Res,2002,53(4):865-871.
5 Veenhof AA,Vlug MS,van der Pas MH,et al.Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care:a randomized trial[J].Ann Surg,2012,255(2):216-221.
6 Deegan CA,Murray D,Doran P,et al.Effect of anaesthetic technique on oestrogen receptor-negative breast cancer cell function in vitro[J].Br J Anaesth,2009,103(5):685-690.
7 Paswan SS,Kataria K,Parshad R,et al.Feasibility of fast track discharge in breast cancer patients undergoing definitive surgery and impact on quality of life:a prospective study from tertiary care center in India[J].J Suurg Oncol,2015,111(3):265-269.
8 Finnerty CC,Mabvuure NT,Ali A,et al.The surgically induced stress response[J].JPEN J Parenter Enteral Nutr,2013,37(5 Suppl):21-29.
9 Bugada D,De Gregori M,Compagnone C,et al.Continuous wound infusion of local anesthetic and steroid after major abdominal surgery:study protocol for a randomized controlled trial[J].Trials,2015,16(1):357-364.
10 Kohl BA,Deutschman CS.The inflammatory response to surgery and trauma[J].Curr Opin Crit Care,2006,12(4):325-332.
11 Kehlet H,Wilmore DW.Evidence-based surgical care and the evolution of fast-track surgery[J].Ann Surg,2008,248(2):189-198.
12 Gillis C,Carli F.Promoting perioperative metabolic and nutritional care[J].Anesthesiology,2015[Epub ahead of print].
13 Kehlet H,Slim K.The future of fast-track surgery[J].Br J Surg,2012,99(8):1025-1026.
14 李仙洲,刘海,邓阳波,等.肾上肾盐水在乳腺癌改良根治术皮瓣游离中的应用[J].实用肿瘤学杂志,2007,21(3):236-237.
15 Ansari D,Gianotti L,Schroder J,et al.Fast-track surgery:procedure-specific aspects and future direction[J].Langenbeck Arch Surg,2013,398(1):29-37.

[1]	王晓雅,肖斌,廖扬,唐荣芝,孙朝晖,李林海. CXCR家族蛋白在不同乳腺癌亚型中的表达及临床预后分析[J]. 实用肿瘤学杂志, 2019, 33(3): 206-210.
[2]	李烁,张楠楠,李亮亮,龙志平,尹慧慧,赵亚双,王帆. 外周血白细胞PDE4C基因甲基化及环境因素交互作用与乳腺癌发病的关系[J]. 实用肿瘤学杂志, 2019, 33(3): 233-238.
[3]	李嘉琪,栾瑾微,张,玉,李香兰. 763例三阴性乳腺癌临床病理特征及复发、转移影响因素分析[J]. 实用肿瘤学杂志, 2019, 33(3): 244-249.
[4]	陈艳波, 孔德嘉, 张金锋, 马志刚. 乳腺癌患者CYP2D6基因多态性与他莫昔芬代谢相关性研究[J]. 实用肿瘤学杂志, 2019, 33(2): 110-114.
[5]	孙江宏, 郝明珠, 姜丹, 国飞, 李晓梅. 乳腺炎、良性增生及乳腺癌FFDM鉴别诊断思路[J]. 实用肿瘤学杂志, 2019, 33(2): 139-141.
[6]	马志杰, 王帆, 赵亚双. 乳腺癌化疗患者生存质量及影响因素分析[J]. 实用肿瘤学杂志, 2019, 33(2): 149-154.
[7]	马质莹, 尚乃舰, 蔡妙田, 沈阳, 姜智允. 孕激素及雌激素受体阳性乳腺癌HER-2受体与钼靶影像学特征及临床病理学特征的相关性分析[J]. 实用肿瘤学杂志, 2019, 33(1): 47-51.
[8]	何煦, 叶尚勉, 董丹丹, 李科. HLA-G在乳腺癌中的表达及意义[J]. 实用肿瘤学杂志, 2018, 32(5): 410-414.
[9]	王志, 刘忠卫, 曾雪芸, 隋明洁, 廖静怡, 李月欢, 黄卫东, 刘国祥. 基于EQ-5D-5L的结直肠癌癌前病变患者健康相关生命质量研究[J]. 实用肿瘤学杂志, 2018, 32(4): 320-326.
[10]	孙祖刚, 王哲, 陈怀安, 刘硕, 苗文隆. 诱发膀胱癌的常见慢性炎症因素及其免疫治疗的研究进展[J]. 实用肿瘤学杂志, 2018, 32(4): 357-361.
[11]	林荣杰, 尹航, 周云峰. ON123300对ER阳性人乳腺癌MCF-7细胞的影响及机制研究[J]. 实用肿瘤学杂志, 2018, 32(3): 193-197.
[12]	李林(综述), 李志高(审校). 二甲双胍与不同分子亚型乳腺癌的关系[J]. 实用肿瘤学杂志, 2018, 32(3): 267-270.
[13]	雷婉婷, 王静萱. 肿瘤微环境在肿瘤细胞有氧糖酵解中的作用[J]. 实用肿瘤学杂志, 2018, 32(2): 189-192.
[14]	郑伟, 许守平, 庞达. 长链非编码RNA Linc00152在泛癌中表达、预后及功能研究[J]. 实用肿瘤学杂志, 2018, 32(1): 7-13.
[15]	殷玉莲, 张卫红, 周悦, 叶媚娜, 陈红风. ERα基因单核苷酸多态性与乳腺癌应用芳香化酶抑制剂引发骨丢失的相关性研究[J]. 实用肿瘤学杂志, 2018, 32(1): 14-18.

加速康复外科对乳腺癌改良根治术患者应激及炎症反应的影响

The influence of fast track surgery on stress and inflammatory response in breast cancer patient s treated with modified radical mastectomy

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价