术中放疗技术应用于早期乳腺癌保乳手术的临床分析  

Clinical analysis of intraoperative radiotherapy in breast-conserving surgery of early breast cancer

作　　者：王昕[1] 冯勤付[2] 王文彦[1] 高纪东[1] 宣立学[1] 王靖[1] 李晔雄[2] 王翔[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院乳腺外科,北京100021 [2]中国医学科学院北京协和医学院放射治疗科,北京100021

出　　处：《中华医学杂志》2013年第48期3861-3863,共3页National Medical Journal of China

基　　金：首都临床特色应用研究项目（Z111107058811093）

摘　　要：目的探讨早期乳腺癌保乳术中采用术中电子线局部放疗取代常规术后全乳放疗的安全性和可行性。方法对中国医学科学院肿瘤医院2008年7月至2012年12月收治的36例早期乳腺癌女性患者采用Mobetron1000移动式电子束术中放疗系统行保乳手术后联合局部术中放疗。观察初步治疗效果、切口愈合情况、美容效果及不良反应。结果中位随访时间27．9个月，截止至随访日，2例（5．56％）出现局部复发后行全乳切除术，全部患者均未出现远处转移，无死亡病例。2例（5．56％）出现切口感染，2例（5．56％）出现切口延迟愈合，中位愈合时间17d。1例（2．78％）有切口水肿。未见切口脂肪液化或血肿。美容效果评价：32例优秀或良好（88．89％），4例一般或差（11．11％）。不良反应：未见术中放疗相关急性血液学毒性。2例（5．56％）出现轻度皮肤色素沉着。结论术中放疗的近期疗效尚可，美容效果好，不良反应小，并发症少见，临床安全性高，而远期疗效等评价仍需进一步研究。Objective To evaluate the safety and feasibility of intraoperative radiotherapy during breast-conserving surgery instead of whole breast radiotherapy in early breast cancer patients. Methods From July 2008 to December 2012, 36 early breast cancer patients underwent breast-conserving surgery plus interoperative radiotherapy on a Mobetron 1000 mobile electron accelerator. Postoperative recurrence and metastases, complications and cosmetic outcomes were recorded and analyzed. Results During a median follow-up period of 27.9 months, 2 patients（5.56% ）underwent mastectomy after local relapses. There was no occurrence of distant metastasis or mortality. Their average wound healing time was 17 days and 2 of them （5.56%） developed infection while another 2 （5.56%） had delayed wound healing. And 1 patient （2.78%） showed wound edema and neither lyponecrosis nor hematoma was found. The evaluation of cosmetic outcome shows 32 patients（ 88.89% ）were graded as excellent or good while another 4 （11.11% ） fair or poor. None had radiotherapy-related acute hemotological toxicity and 2 patients （ 5.56% ） developed skin pigmentation. Conclusion Intraoperative radiotherapy during breast-conserving surgery instead of whole breast radiotherapy in early breast cancer patients is both safe and reliable with better cosmetic outcomes.

关 键 词：乳腺肿瘤 乳房成形术 放射疗法 

分 类 号：R737.9[医药卫生—肿瘤]