不同手术范围及区段形态对乳腺癌保乳切缘影响的对比研究  

INFLUENCE OF DIFFERENT EXTENTS OF SURGERY AND SEGMENTAL RESECTION SHAPES ON THE RESECTION MARGIN OF BREAST-CONSERVING SURGERY FOR BREAST CANCER:A COMPARATIVE STUDY

作　　者：任辉 邵长卿 冯静 宋海平 王启堂[1] 陈耀坤 REN Hui;SHAO Changqing;FENG Jing;SONG Haiping;WANG Qitang;CHEN Yaokun(Department of Breast Surgery, The Second Affiliated Hospital of Qingdao University, Qingdao 266042, China)

机构地区：[1]青岛大学医学院第二附属医院,青岛市中心医院乳腺外科,山东青岛266042

出　　处：《精准医学杂志》2021年第4期331-334,共4页Journal of Precision Medicine

基　　金：青岛市2017年度医药科研指导计划(2017-WJ-ZD061)。

摘　　要：目的探讨乳腺癌保乳手术中,采用梭柱型或圆柱型区段切除对保乳切缘肿瘤残留的影响,比较两种方法的优缺点,以期寻找一种兼顾两种方法优点的手术方式。方法对于行乳腺癌保乳术的入组患者分别采用梭柱型保乳区段切除术(A组)或圆柱型保乳区段切除术(B组),比较两种术式手术标本切缘的肿瘤残留情况;随访比较两组患者术后1年内局部复发及远处转移情况;术后半年对患者进行保乳术后乳腺外观的满意度调查,进而寻找最佳的手术方式,以确保在完全切除肿瘤的前提下,尽可能减少手术对正常腺体的副损伤。结果A组标本侧切缘、乳头对侧切缘的肿瘤残留患者数与B组比较,差异无显著性(P>0.05);两组标本乳头近端切缘的肿瘤残留患者数比较,差异有显著性(χ^(2)=4.11,P<0.05)。术后1年A、B组局部复发率及远处转移率比较差异无显著性(P>0.05)。术后半年满意度调查显示,B组患者对于乳腺外观满意度高于A组,差异有显著性(χ^(2)=4.02,P<0.05)。结论在肿瘤安全性方面,梭柱型保乳区段切除术优于圆柱型保乳区段切除术,但却比后者有更大的副损伤。乳腺癌保乳术乳头近端切缘有必要切至乳头下方,而乳头对侧切缘以及侧切缘只要切至肿瘤旁开1 cm即可,不需要过多切除远端腺体。Objective To investigate the influence of fusiform segmental resection versus cylindrical segmental resection on residual tumor at the resection margin of breast-conserving surgery,and to find a surgical method with the advantages of both methods.Methods The patients who were enrolled for breast-conserving surgery underwent fusiform segmental resection(group A)or cylindrical segmental resection(group B),and the two groups were compared in terms of residual tumor at the surgical margin of surgical specimens.The patients were followed up to compare local recurrence and distant metastasis within 1 year after surgery between the two groups.An investigation was performed for the patients at 6 months after surgery to evaluate the degree of satisfaction with the appearance of the breast and find the optimal surgical procedure,so as to reduce the collateral damage to normal gland while ensuring the complete resection of the tumor.Results There was no significant difference in the number of patients with residual tumor at the resection margin on the specimen side or the contralateral side of the nipple between group A and group B(P>0.05),and there was a significant difference in the number of patients with residual tumor at the proximal resection margin of the nipple between the two groups(χ^(2)=4.11,P<0.05).There were no significant differences in local recurrence rate and distant metastasis rate between group A and group B at one year after surgery(P>0.05).The satisfaction survey at half a year after surgery showed that group B had a significantly higher degree of satisfaction with the appearance of the breast than group A(χ^(2)=4.02,P<0.05).Conclusion Fusiform breast-conserving segmental resection is better than cylindrical breast-conserving segmental resection in terms of tumor safety,but the former will cause more collateral damage than the latter.In breast-conserving surgery for breast cancer,the proximal resection margin of the nipple should be extended to the position below the nipple,while the contralateral and

关 键 词：乳腺肿瘤 乳房切除术 区段 切缘 治疗结果 精准医学 

分 类 号：R737.9[医药卫生—肿瘤] R655.8[医药卫生—临床医学]