早期乳腺癌保乳治疗探讨(附28例报告)

Breast-reserving operation for early-stage breast cancer (report of 28 cases)

目的探讨早期乳腺癌患者保乳手术的适应证、手术方法及注意事项。方法回顾分析近年我院保乳手术28例患者的临床资料。结果本组患者肿瘤直径为0.5～2.5cm,平均1.5cm;肿瘤位于外上象限16例,外下象限2例,内上象限9例,内下象限1例。手术切口采用单切口15例,双切口13例。肿瘤切除后乳房缺损的修复方法采用直接缝合腺体20例、腋侧胸背部皮下组织瓣修复乳腺缺损7例、背阔肌瓣转移乳房成型术1例。术后并发症包括皮下积液2例,上肢水肿1例,下肢静脉血栓1例。术后病理均为浸润型导管癌,淋巴结转移4例。术后均接受放疗和6个周期的化疗,ER和(或)PR检测阳性者接受内分泌治疗。随访6～45个月,平均19个月。全部患者外形满意,随访无肿瘤复发和远处转移。结论对于选择合适的早期乳腺癌病例,保留乳房的乳腺癌切除术是标准术式,手术安全,术后乳房外形正常,患者生存质量提高。

Objective To discuss the indications, surgical procedures of breast-reserving operation for early stage breast cancer. Methods Clinical data of 28 patients with early stage breast cancer who underwent breast-reserving operation were analyzed retrospectively. Results All patients were female with the mean age of 49 years. The mean diameter of the primary tumor was 1.5 cm （range： 0.5-2.5cm）. Tumors were in the upper outer quadrant in 16 cases, in upper inner quadrant in 9 cases, in lower outer quadrant in 2 cases, in lower inner quadrant in 1 case. During operation, single incision approach was used in 15 patients, two incisions approach in 13 patients. Three ways were used to reconstruct breast defections ：simple closing the wounds in 20 patients; local flaps from subaxillary region in 7 patients; latissimus dorsi myocutaneous flap in 1 patient. Postoperative complications included subcutaneous seroma in 2 patients; upper limb edema in 1 patient; venous thrombosis in 1 patient. All patients suffered from invasive duct carcinoma with lymph nodes metastasis. All patients received chemotherapy and radiotherapy after operation. Patients with ER positive and/or PR positive received endocrine therapy. The median follow-up time was 19 months （average 6-45 months）. All patients had accepted the aesthetic results of the operation. No distant metastasis and local recurrence of cancer were detected. Conclusions Breast-reserving surgery is safe in properly selected patients with early stage breast cancer. This standard treatment can achieve an acceptable aesthetic result and the life quality of patients is also improved.