保乳整形术治疗较大肿瘤乳腺癌患者的临床研究

Clinical research of breast plastic techniques in breast-conserving surgery for breast cancer with larger tumors

目的探讨乳房整形术在乳腺癌较大肿瘤手术的可行性及其美容效果。方法收集2012年8月至2016年8月,在天津医科大学肿瘤医院接受乳腺癌手术,肿瘤直径3.0~5.5 cm的198例患者资料,按照不同的手术方式分为:未行新辅助化疗降期,直接行保乳整形术的患者94例(整形组);先行新辅助化疗降期,再行传统保乳术的患者104例(传统组)。比较两组术后并发症、复发转移率、生存率及术后乳房美容效果。结果整形组术中出血量较传统组多,而术后感染发生率较低,差异有统计学意义(P<0.05);术后并发症、局部复发率、远处转移率、总生存率、无病生存率及美容效果在两组间比较,差异均无统计学意义(P>0.05)。结论采取组织替代技术修复乳腺癌保乳手术中局部较大的缺损具有安全、有效、术后美容效果好等优点。

Objective To study the feasibility and cosmetic results of breast plastic techniques in surgery for breast cancer with larger tumors. Methods The research is done by reviewing the cases of 198 cancer patients with tumor diameter between 3.0 cm to 5.5 cm dur- ing August 2012 to August 2016. The patients were divided into two groups according to their surgery types. The oncoplastic surgery group includes 94 patients who directly underwent breast-conserving surgery without undergoing downstaging through neoadjuvant chemotherapy. The traditional group includes 104 patients who underwent downstaging through neoadjuvant chemotherapy before traditional breast-conserving surgery. The two groups were compared in terms of postoperative complications, recurrence and metastasis rate, survival rate and breast cosmetic results. Results Blood loss amount in oncoplastic surgery group was larger while postoperative infection rate was lower than traditional group （P 〈 0.05 ）. There were no signifi- cant statistical differences between the two groups in terms of postoperative complications; local recurrence rate, distant metastasis rate, total survival rate and disease free survival rate as well as cosmetic results （ P 〉 0. 05）. Conclusions It is safe, effective and cosmetically satisfactory to repair the larger local defect by means of tissue substitution in breast-conserving surgery for breast cancer patients.