肿瘤整形技术在早期乳腺癌保乳手术中的临床应用  

Application of oncoplastic techniques in breast-conserving surgery for early breast cancer

作　　者：曹勇[1] 罗杰[1] 周鑫[1] 曾晓华[1] 

机构地区：[1]重庆市肿瘤研究所乳腺中心,重庆400030

出　　处：《中国普通外科杂志》2017年第5期607-613,共7页China Journal of General Surgery

基　　金：重庆市医学科研计划基金资助项目(20141018)

摘　　要：目的:探讨肿瘤整形技术应用于早期乳腺癌保乳术的疗效及安全性。方法:回顾性分析2011年8月—2016年8月139例应用肿瘤整形技术进行保乳手术治疗的I^II期乳腺癌患者临床资料,并与同期1 271例行乳腺癌改良根治术的I^II乳腺癌患者的远期效果比较。结果:139例患者中,133例采用体积易位技术(局部腺体组织瓣转移修补法)进行保乳手术,其中45例同时接受对侧缩乳术,6例采用体积置换技术(自体组织移植修补法);78例行前哨淋巴结活检术,61例接受腋窝淋巴结清扫术。139例乳腺癌患者切除组织标本重30~187 g,平均69.5 g;美容效果评定结果为优秀79例(56.8%)、良好47例(33.8%)、一般10例(7.2%)、差3例(2.2%)。术后随访时间为3~63个月,平均28.8个月;与行改良根治术的患者比较,行肿瘤整形保乳术患者的术后2年局部复发率(4.3%vs.4.1%),总生存率(95.7%vs.95.5%),无病生存率(85.6%vs.85.3%)均无统计学差异(均P>0.05)。结论:应用肿瘤整形技术对早期乳腺癌进行保乳手术具有较好的肿瘤学安全性和满意的美容效果,远期效果与改良根治术相当。选择适合的病例和合理的整形技术,是肿瘤整形保乳术取得最佳的术后效果的关键。Objective： To evaluate the efficacy and safety of using oncoplastic techniques in breast-conserving surgery for early breast cancer. Methods： The clinical data of 139 patients with stageⅠ-Ⅱ breast cancer undergoing oncoplastic breast-conserving surgery from August 2011 to August 2016 were retrospectively analyzed. The long-term outcomes of these patients were also compared with those of 1 271 patients with stage Ⅰ-Ⅱ breast cancer undergoing modified radical mastectomy during the same period. Results： Of the 139 patients, 133 cases underwent breast-conserving surgery with volume displacement technique（local breast tissue flap advancement reconstruction）, of whom 45 cases had synchronous contralateral reduction mammoplasty, and 6 cases received breast-conserving surgery with volume replacement technique （autologous tissue transplantation reconstruction）; 78 cases underwent sentinel lymph node biopsy and 61 cases received axillary lymph node dissection. The weight of resected tissue ranged from 30 to 187 g with average weight of 69.5 g The cosmetic results were determined as excellent in 79 patients, good in 47 patients, ordinary in 10 patients and poor in 3 patients. Postoperative follow-up was conducted for 3 to 63 months with an average of 28.2 months. In patients undergoing oncoplastic breast-conserving surgery, the 2-year local recurrence rate （4.3% vs. 4.1%）, overall survival rate （95.7% vs. 95.5%） and disease free survival rate （85.6% vs. 85.3%） showed no significant difference with those in patients subjected to modified radical mastectomy （all P〉0.05）. Conclusion： Breast-conserving surgery with oncoplastic techniques for early breast cancer offers good oncological safety, satisfactory cosmetic results and long-term outcome similar to modified radical mastectomy. Appropriate selection of patients and oncoplastic procedures are critical for achieving optimal postoperative results in oncoplastic breast-conserving surgery.

关 键 词：乳腺肿瘤 乳房切除术 外科 整形 

分 类 号：R737.9[医药卫生—肿瘤]