纯单孔腔镜非溶脂保乳手术在早期乳腺癌治疗中的临床应用  

Pure single-port lumpectomy non-lipolysis breast-conserving surgery in the treatment of early-stage breast cancer

作　　者：周千贺 尚岳峰 刘通 雷博[1] 史润泽 刘健宇 李志高[1] Zhou Qianhe;Shang Yuefeng;Liu Tong;Lei Bo;Shi Runze;Liu Jianyu;Li Zhigao(Department of Breast Surgery,Harbin Medical University Cancer Hospital,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属肿瘤医院乳腺外科,哈尔滨150081

出　　处：《中华内分泌外科杂志》2023年第2期143-149,共7页Chinese Journal of Endocrine Surgery

基　　金：国家自然科学基金(面上项目)(82073146)。

摘　　要：目的探讨早期乳腺癌患者接受纯单孔腔镜非溶脂保乳手术(pure single-port lumpectomy non-lipolysis breast-conserving surgery,PSLN-BCS)的临床资料及经验。方法回顾性纳入2022年1月至2023年1月哈尔滨医科大学附属肿瘤医院乳腺外科二病房因早期乳腺癌接受保乳手术的患者共400例,分为PSLN-BCS组(200例)和传统保乳手术(conventional breast-conserving surgery,C-BCS)组(200例),观察手术时间,术中出血量,术后3 d内创腔引流量,并随访术后短期(3个月内)并发症情况(术后拔管后积液存留发生率、切口感染发生率),术后远期(3个月后)并发症情况(术区皮肤与胸大肌粘连发生率及保留乳房手术后美容效果)。结果PSLN-BCS对比C-BCS平均手术时间更长(198.341min vs 62.961min,P<0.001,95%CI=132.028min,138.732min)。PSLN-BCS术中出血更少(18.824 ml vs 22.627 ml,P=0.003,95%CI=-6.294 ml vs-1.311 ml)。PSLN-BCS术后引流量更少(346.157 ml vs 406.191 ml),(P<0.001,95%CI=-70.571 ml vs-49.496 ml)。术后短期并发症,如3~6个月皮下积液(χ^(2)=2.33,P=0.127),与切口感染发生(χ^(2)=0.14,P=0.708)均无明显差异。PSLN-BCS 6个月后术区皮肤与胸大肌粘连发生率更低(χ^(2)=11.58,P<0.001),接受PSLN-BCS的患者较接受C-BCS的患者可获得更好的美观度,差异有统计学意义(χ^(2)=273.00,P<0.001)。结论纯单孔腔镜非溶脂保乳手术在早期乳腺癌的治疗中安全有效,可作为有美容要求患者手术术式的一种选择。Objective To summarize the clinical data and experience of pure single-port lumpectomy non-lipolysis breast-conserving surgery(PSLN-BCS)in patients with early-stage breast cancer.Methods A retrospective analysis was conducted on 400 patients who underwent breast-conserving surgery for early-stage breast cancer in the Second Department of Breast Surgery at Harbin Medical University Cancer Hospital from Jan.2022 to Jan.2023.Patients were divided into two groups:PSLN-BCS group(n=200)and conventional breast-conserving surgery(C-BCS)group(n=200).The surgical time,intraoperative blood loss,postoperative drainage within three days,and short-term(3 months to 6 months after surgery)complications,including the incidence of residual fluid after drain removal and incision infection were observed.Long-term(6 months after surgery)complications,including the incidence of skin and pectoralis major muscle adhesions in the surgical area and cosmetic results after breast-conserving surgery,were also evaluated.Statistical analysis was performed using R language,and quantitative data were expressed as mean±standard deviation(±s)and analyzed using t-test,while count data were analyzed usingχ^(2) test.A p-value less than 0.05 was considered statistically significant.Results PSLN-BCS had a longer average surgical time than C-BCS(198.341min vs 62.961min,P<0.001,95%CI:132.028 vs 138.732).PSLN-BCS had less intraoperative bleeding(18.824 ml vs 22.627 ml,P=0.003,95%CI:-6.294 vs-1.311)and lower postoperative drainage volume(346.157 ml vs 406.191 ml,P<0.001,95%CI:-70.571-a-49.496).There were no significant differences in short-term postoperative complications such as subcutaneous fluid accumulation(χ^(2)=2.33,P=0.127)or incisional infection(χ^(2)=0.14,P=0.708)between the two groups.The incidence of skin and muscle adhesions in the surgical area was lower in patients who underwent PSLN-BCS at 6 months postoperatively(χ^(2)=11.58,P<0.001).Patients who received PSLN-BCS achieved better cosmetic outcomes,with a statistically significant diff

关 键 词：乳腺癌 纯单孔腔镜 保乳手术 导丝定位 

分 类 号：R737.9[医药卫生—肿瘤]