个体化乳腺癌保乳术165例临床分析

Clinical analysis on individualized breast-conserving surgery for 165 patients with breast cancer

目的探讨标准保乳术和整形保乳术在乳腺癌保乳术中的合理选择及应用。方法将既往接受保乳术的165例患者分为标准保乳组(n=64)和整形保乳组(n=101),比较两组的肿瘤特点、手术方式、术后并发症及术后美容效果。结果标准保乳组和整形保乳术组在术后并发症、美容效果、复发转移事件的差异均无统计学意义(P>0.05);两组在肿瘤分布位置、切除组织量、乳房大小、原发肿瘤大小或范围、是否行新辅助化疗的差异有统计学意义(P<0.05);整形保乳组切除乳房组织量大于标准保乳组;应用整形保乳术的原发肿瘤更多见于中央区、内上象限、下象限。结论对保乳患者进行分阶段动态评估、具体情况具体分析的个体化保乳模式保证了良好的术后乳房美观效果;整形保乳术可切除更多的组织量以保证切缘阴性,增加了保乳成功率且减少了不必要的乳房全切及乳房再造手术,值得进一步临床研究和推广。

Objective To investigate the reasonable selection and application of standard breast-conserving surgery and onco-plastic breast-conserving surgery for breast cancer. Methods A total of 165 patients that underwent breast-conserving surgery were di-vided into two groups：group of standard breast-conserving surgery （ n=64 ） and group of oncoplastic breast-conserving surgery （ n=101） . The tumor features, surgical procedures, postoperative complications and cosmetic outcome of the operation were compared be-tween both groups. Results There was no statistical difference concerning the postoperative complications, cosmetic outcome, recur-rence and metastasis between the 64 cases of standard breast-conserving surgery group and the 101 cases of oncoplastic breast-conser？ving surgery group. There was statistical difference concerning the location distribution of tumor, weight of the surgical specimen, breast size, size or scope of primary tumor and the neoadjuvant chemotherapy between both groups. The weight of the surgical specimen was greater in oncoplastic breast-conserving surgery group than that in standard breast-conserving surgery group. The primary tumor applying oncoplastic breast-conserving surgery was more in the central zone, the upper inner quadrant and the lower quadrant. Conclusion The individualized breast-conserving model can better insure the breast cosmetic outcome of the operation with staging dynamic evaluation and concrete analysis of concrete conditions to the breast-conserving patients. The oncoplastic surgery makes it possible to excise more tissues in breast-conserving surgery, so as to ensure the negative margin and increase the success rate of the breast-conserving surgery, thus reducing the unnecessary mastectomy and breast reconstruction. It deserves further clinical research and promotion.