早期乳腺癌保乳手术247例报告

Adoption of breast-conservating therapy in patients with early stage breast cancer

目的:探讨早期乳腺癌保乳手术的技巧和近期疗效。方法:1995年～2004年收治女性乳腺癌2548例,选择临床0I～Ia期、非乳晕区单发肿瘤247例施行保乳手术。对肿瘤直径<2cm者,行肿瘤局部扩大切除;对肿瘤直径2～3cm者则行象限切除,切缘行冰冻检查,常规腋淋巴结清扫。乳晕部残留腺体作阶梯状对缝。术后胸壁行50Gy放疗,瘤床追加10Gy放疗。腋窝淋巴结阳性及高危病人接受化疗;雌激素受体阳性者接受内分泌治疗。结果:247例手术全部成功,无并发症发生。总保乳率9.7%(247/2548),占同期乳腺癌保乳率22.6%,美容满意率达93.6%。平均随访69个月,随访率74.1%(183/247例)。局部复发率1.63%(3/183例),腋淋巴结复发率1.09%(2/183例),复发时间为术后3年2个月;远处转移率1.09%(2/183例),术后4年半1例肺转移,1例肝转移;随访期中,死亡3例,1例死因为心肌梗死,2例为肺、肝转移;5年无病生存率95.6%(175/183例),总生存率98.4%(180/183例)。结论:乳腺癌保乳手术近期总疗效属满意。

Objective To evaluate the therapeutic effect of breast-conservating therapy in patients with early stage breast cancer. Methods Retrospective review was carried out in 2 548 women with breast cancer admitted during the period from 1995 to 2004. Among the total, 247 patients belonged to clinical stage 0-Ⅱ a, with a single lesion which did not locate in the areola and were submitted to breast conservation therapy. Patients with tumor msasuring 〈2 cm in diameter received resection of the breast nodule, while those with tumor measuring 2-3 cm in diameter received a quadrantectomy, with frozen section of the margins and the axillary lymph nodes dissection; the remaining gland was sewed up into ladderlike shape. Surgery was followed by 50 Gy of radiation to the whole breast with 10 Gy of tumor bed boost. Besides, patients carrying higher risks or positive axillary nodes were given chemotherapy, and those with positive estrogen receptor were given endocrine therapy. Results No post-operative complications occurred in the 247 patients. A contentment rate of 93.6% resulted according to the evaluation criterion of Rosa. After a mean period of 69 months, 74.1% of patients （1831247） were followed up. The rate of local recurrence was 1.63%（3/183）and the axillary recurrence rate was 1.09% （2/183）. The rate of metastasis was 1.09%（2/183）. One pulmonary metastasis and another liver metastasis were observed after 4.5 years of operation. Three patients died during the follow-up period, one died of myocardial infarction, and 2 of lung and liver metastasis. The 5-year disease-free and overall survival rate were 95.6% （175/183）and 98.4% （180/183）respectively. Conclusions Breast-conservating therapy is an appropriate method in short period for the female patients with early stage breast cancer.