微创旋切术用于老年乳腺良性肿块患者对手术指标、应激反应和免疫功能的影响

摘要 目的：对比分析微创旋切术和传统开放手术对老年乳腺良性肿块患者手术指标、应激反应、免疫功能的影响及安全性。方法：收集我院2015年4月~2019年2月因乳腺良性肿块需手术治疗的老年患者148例，按不同手术方式分为观察组和对照组，每组74例。观察组予以微创旋切术，对照组予以传统开放手术，比较两组手术指标，手术前后应激反应、免疫功能，术后乳房美观性和并发症的发生情况。结果：观察组切口长度、手术时间、出血量、住院时间和术后疼痛评分分别为(2.35±1.45)cm、(18.27±4.51)min、(5.07±1.02)mL、(4.98±1.20)d和(2.88±1.13)分，均低于或短于对照组(P<0.05)；术后血清去甲肾上腺素(NE)、肾上腺素(E)和皮质醇(Cor)水平分别为(71.03±3.02)ng/mL、(68.22±7.23)ng/mL和(101.82±13.29)mmol/L，均明显低于对照组(P<0.05)；手术后免疫功能中CD4⁺、CD3⁺和CD4⁺/CD8⁺分别为(27.27±3.70)%、(44.87±6.13)%和(1.22±0.07)，均显著高于对照组(P<0.05)；术后乳房美观性优良率为98.6%，明显高于对照组(P<0.05)，总并发症发生率为2.7%，显著低于对照组(P<0.05)。结论：与传统开放手术相比，微创旋切术用于老年乳腺良性肿块患者的效果较好，手术时间短，出血少，患者术后疼痛较轻，住院时间短，可有效保护患者的免疫功能，降低应激反应，安全性高。

Effect of Minimally Invasive Surgery on the Surgical Parameters, Stress Response and Immune Function of Elderly Patients with Benign Breast Masses

ABSTRACT Objective: To compare and analyze the effects and safety of minimally invasive surgery and traditional open surgery on surgical parameters, stress response and immune function in elderly patients with benign breast masses. Methods: From April 2015 to February 2019, we collected 148 elderly patients with benign breast masses who needed surgery, according to different surgical methods, it was divided into observation group and control group, with 74 cases in each group, set to observation group and control group, the observation group was treated with minimally invasive surgery, and the control group was treated with traditional open surgery,to compare surgical indicators, stress response before and after surgery, immune function, postoperative breast aesthetics and complications. Results: The incision length, operation time, bleeding volume, length of hospital stay, and postoperative pain scores in the observation group were (2.35±1.45) cm, (18.27±4.51) min, (5.07±1.02) mL, (4.98±1.20) d, and (2.88±1.13) points, both were lower or shorter than the control group (P<0.05). The levels of serum norepinephrine (NE), adrenaline (E) and cortisol (Cor) in the observation group were (71.03±3.02)ng/mL,(68.22±7.23)ng/mL and (101.82±13.29)mmol/L,which were significantly lower than the control group (P<0.05). The CD4⁺, CD3⁺ and CD4⁺/CD8⁺ in the observation group were (27.27±3.70)%, (44.87±6.13)% and (1.22±0.07), which were significantly higher than the control group (P<0.05). The excellent and good rate of breast aesthetics in the observation group was 98.6%, which was significantly higher than that in the control group (P<0.05), the total complication rate was 2.7%, which was significantly lower than that of the control group (P<0.05). Conclusion: Compared with traditional open surgery, minimally invasive resection is effective for benign breast masses, with short operation time, less bleeding, less postoperative pain, and shorter hospital stay, it can effectively protect patients'' immune function and reduce the stress response with high safety.