乳腺癌腋窝单切口腔镜保乳手术和传统开放保乳手术的对比研究  

Comparative study of axillary single-incision endoscopic breast-conserving surgery and conventional open breast-conserving surgery for breast cancer

作　　者：李田园 谢妍妍 邬昊 朱中建 杜正贵[1,2] LI Tianyuan;XIE Yanyan;WU Hao;ZHU Zhongjian;DU Zhenggui(Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Breast Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院普通外科,成都610041 [2]四川大学华西医院乳腺疾病中心,成都610041

出　　处：《中国普外基础与临床杂志》2025年第3期282-287,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省卫生健康委员会医学科技项目-应用项目(项目编号:21PJ042)。

摘　　要：目的比较腋窝单切口腔镜保乳手术与传统开放保乳手术在手术效率、外科学安全性、美容学效果及肿瘤学安全性方面的差异,探讨基于“华西3号孔”的腋窝单切口腔镜保乳手术的临床应用价值。方法回顾性收集2021年1月至2024年9月期间在四川大学华西医院接受乳腺癌保乳手术患者的临床病理资料。根据手术方式将患者分为腔镜保乳手术组和开放保乳手术组(分别简称为“腔镜组”和“开放组”),2组均接受标准化的手术治疗及术后随访。观察指标包括基线资料、术中相关参数、术后并发症、美容学效果(采用Ueda、Harris评分评估)及肿瘤学结局(局部复发及远处转移)。结果共有67例患者入组,其中腔镜组41例,开放组26例,2组患者除了伴有糖尿病及人表皮生长因子受体2阳性者占比(P<0.05)外,其他基线资料比较差异无统计学意义(P>0.05)。腔镜组的美容学效果优于开放组(Ueda评分:P=0.013;Harris评分:P=0.047),腔镜组的中位总住院费用高于开放组(12779.00元比12354.50元,Z=–2.16、P=0.03),2组患者的术后并发症发生率比较差异无统计学意义(P>0.05)。腔镜组和开放组中位随访时间分别为31.43个月和21.20个月(Z=–2.36,P=0.02),随访期间,仅腔镜组有1例发生局部复发,2组均未发生远处转移及死亡事件。结论基于“华西3号孔”的腋窝单切口腔镜保乳手术在手术效率、外科学安全性及肿瘤学安全性方面与传统开放保乳手术相当,同时在术后美容学效果方面更具优势。Objective To compare the differences in surgical efficiency,surgical safety,aesthetic outcomes,and oncological safety between axillary single-incision endocsopic breast-conserving surgery(ASIEBS)and conventional open breast-conserving surgery(COBS),and to evaluate the clinical value of ASILBCS based on the“HUAXI hole 3”technique.Methods A retrospective cohort study was conducted on the clinicopathologic data of patients who underwent breastconserving surgery for breast cancer at West China Hospital of Sichuan University from January 2021 to September 2024.The patients were assigned into an ASILBCS group and a COBS group based on the surgical approach.Both groups received standardized surgical treatment and postoperative follow-up.The observation indicators included baseline characteristics,intraoperative data,postoperative complications,aesthetic outcome(by Ueda score and Harris score evaluation),and oncological safety(local recurrence and distant metastasis).Results A total of 67 patients were enrolled,with 41 in the ASIEBS group and 26 in the COBS group.There was no statistically significant differences in the comparison of other baseline data between the two groups(P>0.05),except for the proportions of patients with diabetes mellitus and those positive for human epidermal growth factor receptor 2(P<0.05).The ASIEBS group showed superior aesthetic outcomes compared to the COBS group(Ueda score:P=0.013;Harris score:P=0.047).However,the ASIEBS group had higher median total hospitalization costs(12779.00 yuan vs.12354.50 yuan,Z=–2.16,P=0.03).The median follow-up time was 31.43 months in the ASIEBS group and 21.20 months in the COBS group(Z=–2.36,P=0.02).During follow-up,only one patient with local recurrence occurred in the ASIEBS group,and no distant metastasis or death event was observed in both groups.Conclusion The ASIEBS based on the“HUAXI hole 3”technique is comparable to COBS in terms of surgical efficiency,surgical safety,and oncological safety,while offering superior aesthetic outcomes.

关 键 词：乳腺癌 开放保乳手术 腋窝单切口腔镜保乳手术 美容学效果 肿瘤学安全性 

分 类 号：R73[医药卫生—肿瘤]