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

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.