腔镜辅助下乳腺癌保留乳房手术的临床研究

Prospective study of endoscopy-assisted breast-conserving surgery

目的:探讨腔镜辅助下乳腺癌保留乳房手术治疗早期乳腺癌的可行性。方法:连续收集2005-05-2008-12于我科行腔镜辅助下乳腺癌保留乳房手术(腔镜组,82例)及乳腺癌改良根治术(对照组,65例)患者的临床资料,两组均配合直视下腋窝前哨淋巴结活检术(SLNB)或加做腋窝淋巴结清除术。患者术后定期门诊随诊,美容效果以调查问卷形式进行评估。结果:两组在临床分期、肿瘤所在象限、病理类型、前哨淋巴结(SLN)检出个数、SLN检出率、腋窝淋巴结检出个数、无复发生存率,以及总生存率方面差异无统计学意义。腔镜组较对照组的手术用时长,术中出血量少,术后引流总量少,术后引流时间短,腔镜组患者术后对胸部外观的满意度高。结论:腔镜辅助下乳腺癌保留乳房手术用于部分早期乳腺癌患者的美容效果好,而且肿瘤安全性指标与传统手术相当。

OBJECTIVE： To evaluate the feasibility and outcome of endoscopy-assisted breast-conserving surgery for early-stage breast cancer. METHODS： 82 patients （endoscopy group） and 65 patients （control group） with early-stage breast cancer admitted to the First Affiliated Hospital of Guangzhou Medical College from May 2005 to December 2008 were continuously enrolled in the study. The endoscopy group and the control group undertook endoscopy-assisted breast- conserving surgery and modified radical mastectomy, respectively. Both of them were combined with sentinel lymph node biopsy （with axillary lymph node dissection if necessary） under direct vision. Data for clinicopathological characteristics, perioperative indicators, outcomes and aesthetic results were collected and analyzed. RESULTS： The clinical staging, tumor site, pathologic type, amounts of sentinel or axillary lymph nodes, detection rate of sentinel lymph node, recur- rence-free survival rate, and overall survival rate were statistically equivalent between the two groups. Additionally, comparing with the control group the endoscopy group presented a longer operation time, less blood loss or drainage and shorter drainage duration as well as a better aesthetic outcome （P〈0.05）. CONCLUSIONS： As an aesthetic surgery, endos- copy-assisted breast-conserving surgery seems to be feasible and safe for part of patients with early-stage breast cancer.