妊娠期乳腺癌在诊断和手术、化疗、放疗综合治疗方面的特殊性探讨

Exploration of specificity of pregnancy breast cancer in diagnosis and comprehensive treatment combining surgery,chemotherapy and radiotherapy

目的对妊娠期乳腺癌的诊断、手术、放疗、化疗等综合治疗方面的特殊性进行探讨。方法回顾性分析自2000年5月～2007年5月期间某院收治的妊娠期乳腺癌患者11例，其中属于妊娠期的有5例，分娩后1年内的有6例。对7例患者实施了乳房保留治疗，4例实施改良根治术，且所有患者在术后进行放疗，有8例接受了化疗。结果11例患者通过钼靶检查中有9例以及6例B超检查都发现了阳性。由于诊断时期较晚，因此其肿瘤Ⅰ期、Ⅱ期、Ⅲ期例数为2例、5例、4例。对所有患者进行随访发现，有9例无病生存，有2例在结束治疗2年后出现局部复发或者转移。结论妊娠期乳腺癌的误诊是较为常见的，因此在诊断时，要重视妊娠、哺乳等时期对乳房的检查以及超声检查的作用。在治疗时要坚持兼顾疾病迫切性和胎儿安全性的原则。研究表明在允许开展化疗及放疗的综合治疗前提下，进行乳房保留治疗是治疗妊娠期乳腺癌的可行方法。

Objective To explore the specificity of pregnancy breast cancer in the diagnosis and the comprehensive treatment combining surgery, radiotherapy and chemotherapy. Methods Eleven patients with pregnancy breast cancer treated in one hospital from May 2000 to May 2007 were analyzed retrospectively, of which 5 patients were in pregnancy and 6 patients were within 1 year after delivery. Seven patients received breast-conserving treatment and 4 patients received modified radical operation. All the patients received postoperative radiotherapy and 8 patients received chemotherapy. Results Of the 11 patients, molybdenum target examination found 9 positive patients and B ultrasound found 6 positive patients. Because the diagnosis was late, the numbers of patients with stage Ⅰ , stage Ⅱ and stage m tumor were 2, 5 and 4. Follow-up of all the patients found that 9 patients survived and were free of the disease and 2 patients had local relapse or metastasis 2 years after the treatment. Conclusion Misdiagnosis of pregnancy breast cancer is commonly seen, so the role of mammary examination and ultrasound examination during the pregnancy and lactation periods should be emphasized in the diagnosis. In the treatment, the urgency of disease and the safety of fetuses should be considered at the same time. The study shows that on the premise of allowing the comprehensive treatment combining chemotherapy and radiotherapy, breast-conserving treatment is a feasible way to treat pregnancy breast cancer.