RESUMO
Objective:To explore the effect of mastoscopic axillary lymph node dissection (MALND) and conventional axillary lymph node dissection (CALND) in breast conserving surgery for breast cancer.Methods:This study adopts a case-control study. We selected 40 female breast cancer patients who underwent MALND in Tangshan People's Hospital from July 2016 to August 2019 (observation group), and 40 female breast cancer patients who underwent CALND in the same period as the control group. The two groups of patients were operated by the same group of doctors. After tracheal intubation and general anesthesia, the patients underwent breast conserving surgery first. After the intraoperative frozen pathology showed that breast conserving was successful, the control group underwent MALND, and the observation group underwent breast endoscopic axillary lymph node dissection. The levels of blood biochemical indicators, inflammatory factors, stress response indicators, myocardial injury markers and tumor blood circulation micrometastasis indicators, the number of lymph node dissection, operation time, intraoperative bleeding, postoperative drainage, hospital stay, hospital expenses and other surgical observation indicators, as well as the incidence of postoperative complications were compared between the two groups 3 days after operation. The measurement data with normal distribution was expressed by xˉ± s, and the comparison between the two groups was conducted by independent sample t-test; The counting data was expressed in cases (%), and the χ 2 test or Fisher exact probability method was used for comparison between groups. Results:Three days after operation, the erythrocyte count and hemoglobin level in the observation group were lower than those in the control group ((4.03±0.57)×10 12/L vs (4.33±0.54)×10 12/L, (110.90±24.20) g/L vs (129.70±14.90) g/L), cTnI, creatine kinase and CK-MB levels were higher than those in the control group ((17.4±2.3) μg/L vs (13.1±1.8) μg/L, (178.1±35.4) U/L vs (133.1±45.1) U/L, (10.7±1.6) U/L vs (7.0±1.2) U/L), the operation time was longer than that of the control group ((89.4±15.6) min vs (69.6±13.8) min), the intraoperative bleeding volume and postoperative drainage volume were more than that of the control group ((69.5±6.4) mL vs (33.3±7.7) mL, (334.5±51.1) mL vs (236.8±44.3) mL), but the hospital stay was shorter than that of the control group ((7.1±3.1) d vs (15.5±4.7) d). The cost of hospitalization was lower than that of the control group ((13 689.7±1 204.2) yuan compared with (19 734.5±1 391.5) yuan), and the difference was statistically significant ( t values were 2.16, 3.71, -11.69, -4.68, -11.34, -6.01, -22.87, -9.14, 9.44, 20.78; all P<0.05). There was no statistically significant difference between the two groups in inflammatory factors, stress response indicators, cell adhesion factor levels, number of lymph node dissection and postoperative complications (all P>0.05). Conclusions:Compared with CALND, MALND for breast cancer patients will not cause serious inflammatory reaction and stress reaction, and will not increase the risk of tumor blood micrometastasis and the incidence of complications, but will cause some damage to myocardial cells. Lipolysis and liposuction during MALND can increase intraoperative bleeding volume and postoperative drainage volume, and prolong the operation time while improving the quality of the operation field, However, it has obvious advantages in shortening hospitalization time and reducing hospitalization expenses.