乳腺癌外科十大热点  

Top ten hot topics in breast cancer surgery

作　　者：张群 李俊杰 Qun Zhang;Junjie Li(Department of Breast Surgery,Fudan University Cancer Hospital,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院乳腺外科,上海200032

出　　处：《中华乳腺病杂志(电子版)》2025年第1期6-11,共6页Chinese Journal of Breast Disease(Electronic Edition)

摘　　要：无论是传统的术后辅助治疗(如化疗、放射治疗和内分泌治疗等),还是通过新辅助治疗(NAT)实现降期手术、减瘤、保留乳房及腋窝淋巴结等目的,外科治疗始终是乳腺癌的主要治疗手段。近年来,为了在手术切口最小化的同时实现最大的临床获益,精准化外科治疗逐渐成为研究热点,并引起了广泛关注。 基于此,本文总结并讨论了近期乳腺癌外科治疗的十大研究热点,包括保留乳房理念的革新、保留乳房手术切缘的界定、携带胚系BRCA 基因突变患者保留乳房、NAT 后保留乳房手术、NAT后豁免手术的可行性、前哨淋巴结活组织检查的豁免、前哨淋巴结低负荷转移的处理、NAT 后腋窝降阶梯治疗、初诊Ⅳ期乳腺癌的局部治疗及腔镜和达芬奇机器人辅助等微创手术技术的应用,旨在为进一步实现乳腺癌外科治疗的精准化和规范化提供参考。Whether applying adjuvant treatment including radiotherapy, chemotherapy and endocrine therapy after traditional surgery, or performing neoadjuvant therapy to achieve debulking, breast and axillary lymph node conservation, surgery is always primary treatment for breast cancer. In recent years, an increasing number of researches have focused on precision surgical treatment, in order to realize minimal surgical incision and maximal clinical benefit at the same time. Therefore, this article summarized the top ten hot issues in surgical treatment of breast cancer, including concept innovation of breast conservation, definition of breastconserving surgery margins, breast conservation of germline BRCA mutation patients, breast-conserving surgery after neoadjuvant therapy, feasibility of surgery exemption after neoadjuvant therapy, exemption of sentinel lymph node biopsy, treatment of low-burden metastases in sentinel nodes, de-escalation therapy of axillary nodes after neoadjuvant therapy, local treatment of newly diagnosed stage Ⅳbreast cancer and minimally invasive surgery such as endoscopic and Da Vinci-assisted robotic surgery, in order to provide a refence for precision and standardization of surgical treatment in the future.

关 键 词：乳腺肿瘤 新辅助治疗 前哨淋巴结 保留乳房手术 降阶梯治疗 

分 类 号：R737.9[医药卫生—肿瘤]