乳腺癌保乳手术治疗148例分析

Conservative surgery for the treatment of breast cancer:Analysis of 148 cases

目的 研究乳腺癌保乳治疗方法的选择 ,探讨保乳手术适应证及疗效。 方法 回顾分析 1996年 1月～ 2 0 0 3年 10月我院接受保乳治疗的 14 8例乳腺癌临床资料。 0期 5例 ,Ⅰ期 85例 ,Ⅱ期 5 5例 ,Ⅲ期 3例。手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清扫。术后常规行辅助放疗、化疗和内分泌治疗。 结果 手术标本石蜡病理检查各切缘均无癌浸润。经过 5 4个月中位随访期 (范围 2～ 84个月 ) ,局部复发率为 2 7% ( 4 /14 8) ,其中乳腺 3例 ,腋窝 1例 ;远处转移率3 4 % ( 5 /14 8) ,手术至远处转移间期 6～ 4 3个月 ,转移部位分别为肺、肝、脑膜和骨 ,其中 3例死亡。对保乳综合治疗结束后满1年的 10 8例患者进行乳房外形的评估 ,优 32 4 % ( 35 /10 8) ,良 4 9 1% ( 5 3/10 8) ,差 18 5 % ( 2 0 /10 8)。 结论 对早期乳腺癌及部分经新辅助化疗降期后的局部进展期乳腺癌进行保乳手术治疗效果满意。规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键。

Objective To investigate the therapeutic procedures,indications and efficacy of breast-conserving therapy (BCT). Methods BCT was carried out in 148 patients with breast carcinoma in this hospital from January 1996 to October 2003.There were 5 patients in stage 0,85 patients in stage Ⅰ,55 patients in stage Ⅱ,and 3 patients in stage Ⅲ.The surgical treatment was quadrantectomy or local wide excision of tumor,combined with axillary lymph node dissection.Routine adjuvant irradiation,chemotherapy and hormone therapy were given postoperatively. Results Pathological examinations of breast specimens found no positive margins.Follow-up observations for a median of 54 months (range,2 ～ 84 months) revealed a local recurrence rate of 2 7% ( 4/148 ;3 patients in breast and 1 patient in axillary fossa).Distant metastasis occurred in 5 patients (3 4%) and 3 of them died.Sites of metastasis included lung,liver,meninges and bone.The duration from surgery to distant metastasis was 6 ～ 43 months.Evaluation of cosmetic results in 108 patients who had received BCT for at least 12 months showed that good outcomes were achieved in 32 4% of the patients (35/108),fair outcomes,in 49 1% of the patients (53/108),and poor,in 18 5% (20/108). Conclusions For patients with early stage breast carcinoma,and part of those with local advanced breast cancer who have received neoadjuvant chemotherapy and gotten downstaging effects,the effects of BCT is satisfactory.Standard excision,postoperative irradiation and systemic combination treatment are crucial to BCT.Most patients receiving BCT have good cosmetic results.