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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 effect of postoperative adjuvant local perfusion chemotherapy on prognosis of patients with breast cancer and to discuss the operation methods and precautions when the chemotherapy pump is inserted into the surgical field during the operation. Methods Totally 102 patients with stage Ⅱ-Ⅲ breast cancer were collected. Twenty-three patients (control group) underwent simple quadrant excision plus axillary lymph node dissection or modified radical mastectomy. In addition to surgery, 79 patients (control group) In the lateral thoracic artery or subscapular artery to the axillary artery into the catheter chemotherapy, the tail through the subcutaneous leads, then chemotherapy pump, and fixed on the skin surface, prepared for local adjuvant chemotherapy. 1 week after the administration of heparin red tube 1, to prevent blockage of the pump tube. Fluorouracil (5-FU) and 0.25g / time were injected into the body 10 ~ 14d after operation. The total volume was 1.0g. After the last partial perfusion, the pump tube was removed, the pump body was removed, and the armpit was appropriately pressurized to reduce Local hematoma; postoperative conventional radiotherapy, systemic chemotherapy and endocrine therapy. The patients were followed up for 18-48 months and the local recurrence was observed. Results The operation time was 94 ~ 137 (103 ± 14) min in the control group, 105 ~ 158 (126 ± 17) min in the pump group, and 15 ~ 60 (25 ± 3) min in the local perfusion chemotherapy. In the pump group, 5 cases (6.3%) of the pump tubes pierced the exudate and nearby skin effusion, and 3 cases (3.8%) had small hematoma after extubation but absorbed themselves without affecting the upper limbs. During the follow-up period, there was no local recurrence in the pump group and two cases in the control group. Conclusion Postoperative adjuvant local infusion chemotherapy can reduce the local recurrence rate. Intraoperative chemotherapy pump increases the operation time, but does not cause serious complications.