术中放射治疗在早期乳腺癌保留乳房手术中的应用  

Clinical application of intraoperative radiotherapy in breast-conserving surgery for early breast cancer

作　　者：王丹 朱见 王军 刘长瑞 翟东亮 刘懿心 刘源源 明珊珊 贺青卿 Wang Dan;Zhu Jian;Wang Jun;Liu Changrui;Zhai Dongliang;Liu Yixin;Liu Yuanyuan;Ming Shanshan;He Qingqing(Department of Thyroid and Breast Surgery,960th Hospital of Chinese PLA,Jinan 250031,China)

机构地区：[1]解放军第960医院甲状腺乳腺外科,济南250031

出　　处：《中华乳腺病杂志（电子版）》2024年第1期11-17,共7页Chinese Journal of Breast Disease(Electronic Edition)

基　　金：山东省自然科学基金(ZR2012HM072)。

摘　　要：目的探讨术中放射治疗在早期乳腺癌保留乳房手术中的可行性、临床疗效及美容效果。方法根据纳入及排除标准,回顾性分析2014年1月~2022年1月在解放军第960医院接受保留乳房手术的210例早期乳腺癌患者的临床资料。其中,117例患者接受术中放射治疗(研究组),93例患者接受术后全乳及瘤床加量外照射治疗。随访9~105个月,中位随访时间68个月,随访率100%。对比两组患者并发症发生情况(手术切口相关并发症、放射相关并发症),比较两组患者美容效果、局部肿瘤复发以及死亡事件。组间比较采用χ^(2)检验或Fisher确切概率法,等级资料采用非参数检验。结果手术切口相关并发症:研究组切口脂肪液化4例,切口感染2例,血清肿15例,皮肤破裂瘤床愈合延迟3例;对照组切口脂肪液化1例,切口感染1例,血清肿3例。研究组患者血清肿发生率高于对照组,差异有统计学意义(12.82%比3.23%,χ^(2)=6.087,P=0.014)。放射相关并发症:研究组无放射性肺炎、放射性皮炎、急性血液毒性患者,放射性疼痛5例;对照组放射性肺炎2例、放射性皮炎11例、放射性疼痛10例。研究组患者放射性皮炎发生率低于对照组(0比11.83%,P<0.001)。术后6个月乳腺外观美容效果比较,2组差异有统计学意义(Z=-3.569,P<0.001)。研究组美容效果优良率86.32%(101/117),高于对照组的优良率67.74%(63/93)(χ^(2)=10.460,P=0.001)。随访期间,研究组肿瘤局部复发3例,死亡1例;对照组局部复发1例,死亡1例。2组总生存率、无复发生存率和无转移生存率比较,差异均无统计学意义(χ^(2)=0.004,P=0.953;χ^(2)=0.849,P=0.357;χ^(2)=0.840,P=0.360)。结论早期乳腺癌术中放射治疗安全可行,美容效果好,更经济省时。Objective To investigate the feasibility,clinical efficacy and cosmetic effect of intraoperative radiotherapy in breast-conserving surgery of early breast cancer.Methods According to the inclusion and exclusion criteria,the clinical data of 210 early breast cancer patients who received the breast-conserving surgery in the 960th Hospital of Chinese PLA from January 2014 to January 2022 were retrospectively analyzed.Among them,117 cases were treated with intraoperative radiotherapy(the research group),and 93 cases were treated with postoperative external beam radiation therapy for whole breast and tumor(the control group).All patients were followed up for 9-105 months(median 68 months),and the follow-up rate was 100%.Postoperative complications(surgical incision-related and radiation-related complications)were compared between two groups.The cosmetic effect,local tumor recurrence and mortality were compared between two groups.χ^(2) test or Fisher’s exact test was used for comparison between groups,and the non-parametric test was used for rank data.Results As for the complications related to surgical incision,there were 4 patients with fat liquefaction,2 infection,15 seroma,and 3 delayed healing of ruptured skin in tumor beds in research group,one patient with fat liquefaction,1 infection and 3 seroma in control group.The incidence of seroma in research group was significantly lower than that in control group(12.82%vs 3.23%,χ^(2)=6.087,P=0.014).As for radiotherapy-related complications,there were 5 cases of radiation pain in research group,with no occurrence of radioactive pneumonia,dermatitis or acute hemotoxicity;there were 2 cases of radioactive pneumonia,11 radiodermatitis and 10 radiation pain in control group(P<0.001).The incidence of radiation dermatitis in research group was significantly lower than that in control group(0 to 11.83%,P<0.001).The research group showed a significantly better cosmetic effect of the breast at 6-months follow-up compared with control group(Z=-3.569,P<0.001).The proportion of

关 键 词：乳腺肿瘤 术中放射治疗 局部复发 外照射放射治疗 

分 类 号：R737.9[医药卫生—肿瘤]