顺序法纯单孔腔镜保乳术治疗不同象限早期乳腺癌的疗效研究  

Effectiveness of sequential method pure single-port lumpectomy-breast conserving surgery for early-stage breast cancer in different quadrants

作　　者：周千贺 刘健宇 王文政 李英谱 李志高[1] ZHOU Qianhe;LIU Jianyu;WANG Wenzheng;LI Yingpu;LI Zhigao(Department of Breast Surgery,Harbin Medical University Cancer Hospital,Harbin Heilongjiang,150081,P.R.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：《中国修复重建外科杂志》2024年第7期793-800,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金面上项目(82073146)。

摘　　要：目的比较顺序法纯单孔腔镜保乳术(sequential method pure single-port lumpectomy-breast conserving surgery,SMPSL-BCS)治疗早期乳腺癌时,不同象限肿瘤患者的疗效差异。方法回顾分析2023年1月—12月收治且符合选择标准的200例早期乳腺癌女性患者临床资料。根据肿瘤所在象限,患者分为外上象限组(外上组)、外下象限组(外下组)、内上象限组(内上组)、内下象限组(内下组),每组50例。4组患者年龄、身体质量指数、吸烟史、婚姻状况、合并症、病变乳房侧别、超声检查肿瘤最大直径、病理检查肿瘤最大直径、临床分期、分子分型及病程等基线资料比较,差异均无统计学意义(P>0.05)。记录并比较4组手术时间、术中出血量、术后引流量、拔管时间,术后早期并发症(1~3个月,拔管后皮下积液、切口感染、浅表皮肤灼伤)、远期并发症(>3个月,皮瓣胸大肌粘连、乳房外观和形状改变、感觉不适)发生情况,术后6个月对保乳手术美容效果评级。结果手术时间外上组最短,其次为内上组、外下组,内下组最长,组间差异均有统计学意义(P<0.05)。术中出血量外上组最少,其次为外下组、内上组,内下组最多;除外上组与外下组差异无统计学意义(P>0.05)外,其余组间比较差异均有统计学意义(P<0.05)。术后引流量外上组最少,其次为外下组、内上组,内下组最多;除外下组与内上组差异无统计学意义(P>0.05)外,其余组间比较差异均有统计学意义(P<0.05)。拔管时间内下组明显长于其他组(P<0.05)。4组患者均获随访,随访时间4~12个月,平均8个月;其中193例随访达6个月,其中外上组48例、外下组47例、内上组49例、内下组49例。术后早期,除内下组拔管后皮下积液发生率高于外上组、外下组(P<0.05)外,其余早期并发症发生率组间差异均无统计学意义(P>0.05)。术后远期,内下组皮瓣胸大肌粘连、乳房外观和形状改变发生率�Objective To compare the effectiveness of sequential method pure single-port lumpectomy-breast conserving surgery(SMPSL-BCS)in treating early-stage breast cancer patients with tumors in different quadrants.Methods A retrospective analysis was conducted on 200 early-stage breast cancer female patients admitted between January 2023 and December 2023.According to the quadrant where the tumor was located,the patients were allocated into the upper outer quadrant group(UO group),lower outer quadrant group(LO group),upper inner quadrant group(UI group),and lower inner quadrant group(LI group),with 50 cases in each group.There was no significant difference(P>0.05)in the baseline data,including age,body mass index,smoking history,marital status,comorbidities,affected breast side,maximum tumor diameter on ultrasound,maximum pathological tumor diameter,clinical tumor stage,molecular subtype,and disease duration.The operation time,intraoperative blood loss,postoperative drainage volume,and extubation time were recorded and compared between groups.Additionally,the occurrence of early-stage complications(1-3 months after operation;including subcutaneous fluid accumulation,incision infection,superficial skin burns)and late-stage complications(>3 months after operation;including pectoralis major muscle adhesion,changes in breast appearance and shape,sensory discomfort)were assessed.At 6 months after operation,the cosmetic outcome of breast-conserving surgery was rated for all groups.Results The UO group had the shortest operation time,followed by the UI group,LO group,and LI group,showing significant differences between groups(P<0.05).The UO group had the least intraoperative blood loss,followed by the LO group,UI group,and LI group;except for the difference between UO group and LO group,which was not significant(P>0.05),the differences between the other groups were significant(P<0.05).The UO group had the least postoperative drainage volume,followed by the LO group,UI group,and LI group;except for the difference between LO grou

关 键 词：乳腺癌 顺序法纯单孔腔镜保乳术 导丝定位 肿瘤位置 

分 类 号：R737.9[医药卫生—肿瘤]