乳癌縮小手術（乳房温存術，胸筋温存乳房切除術）を受けた患者の術後回復過程に関する研究(2) : 患者の術式選択時の情報提供のための術式別回復過程の比較

乳癌患者が術式選択を行う場合の情報提供の資料とすることを目的に，乳房温存術（温存術）・胸筋温存乳房切除術（切除術）を受け，術後回復状態を３カ月間縦断的に観察しえたケース３９例において，温存術群（２１例）と切除術群（１８例）の２群にわけ，その２群間の比較を肩関節可動域・握力・創部ドレーン抜去日・胸部の疼痛と日常生活動作で行った．その結果，肩関節可動域は，切除術群・温存術群ともに，前方挙上，後方挙上・側方挙上のすべてにおいて統計的に有意差を認めなかった．しかし，術後１週目には温存術・切除術ともに肩関節可動域は一番低下し，その後３カ月をかけ徐々に回復する経過をたどった．一方，握力は，切除術群の２週目に有意に低下し，切除術は上肢筋力に関して手術侵襲の影響がみられた．術式別の創部ドレーン抜去日および日常生活動作においては，有意差はなかった．術後４週目の創部の動作時の疼痛が，切除術群に比べ温存術群においては「ある」と回答したものが多く，放射線療法による影響が考えられた．乳癌術前患者の術式選択に際しては，単に生存率のみの情報だけでなく，２つの術式には術後の肩関節可動域の制限の程度には差がないこと，温存術に比べ侵襲の比較的大きい切除術では術後２週目に握力の低下を認めること，放射線療法をおこなう温存術では創部の動作時の疼痛の認める例があることなどの，術式により回復のプロセスの違いがある点も情報提示し，対象者のライフスタイルに合わせた術式選択が可能となるよう支援していくことが重要であると考える．

The present study was undertaken to collect data to be utilized for informed choice of operative procedure by patients with breast cancer. The subjects of this study were 39 patients who were followed for 3 months after breast-conserving surgery (the breast conserving group, 21 cases) or pectoral muscle-conserving mastectomy (the mastectomy group, 18 cases). The shoulder joint ROM (range of motion), grip, length of time until withdrawal of the drain, chest pain and activity of daily living (ADL) were compared between the two groups. There was no significant difference in shoulder joint ROM in any direction (anterior, posterior or lateral elevation of the joint) between the breast conserving group and the mastectomy group. In both groups, the shoulder joint ROM was minimal one week after surgery and later recovered gradually over 3 months. Grip was significantly lower in the mastectomy group two weeks after surgery, as compared to the breast-conserving group, suggesting influence of operative stress on the arm muscle strength in the mastectomy group. In terms of the ADL and the length of time from surgery to withdrawal of the drain, there was no significant difference between the two groups. Four weeks after surgery, a higher percentage of patients in the mastectomy group answered to have pain during motion of the surgical wound, as compared to the breast-conserving group, probably reflecting the influence of radiotherapy. These results suggest that when providing information to patients with breast cancer to allow selection of an operative procedure, information should be provided not only concerning expected survival rates, but also about similarities and differences in postoperative recovery between the two procedures, including for example the following information :（1）the degree of restriction of shoulder joint ROM does not differ between the two procedures ; （2）grip may decrease two weeks after pectoral muscle-conserving mastectomy which is more invasive than breast-conserving surgery ; and（3）pain during motion of the wound is sometimes complained after breast-conserving surgery which is combined with radiotherapy. It seems essential to help individual patients select a procedure tailored to their life style on the basis of these pieces of information.