预防性乳腺切除术研究进展

Research advances in prophylactic mastectomy

预防性乳腺切除术是近年来兴起的一种针对乳腺癌高危女性的降低发病风险的手段,美国女性在过去20多年接受该手术的比例大幅增加,且单侧乳腺癌患者选择对侧乳房预防性切除比高风险健康女性选择双侧乳房预防性切除的接受度更高。高危人群选择手术多基于对癌症的恐惧、对乳房对称性的担忧、随访筛查的负担等多重因素。对于健康高危女性,行双侧预防性乳腺切除术可显著降低患乳腺癌的风险,降低死亡率,延长预期寿命,显示出生存获益;对于单侧乳腺癌患者,行对侧预防性乳腺切除术明显降低对侧乳腺癌的发生风险。预防性乳腺切除术结合乳房重建具有良好的美容学效果且显著缓解高危女性心理压力,术后女性的整体满意度高;但术后组织坏死、感染、出血等并发症的风险增加,并可能影响未达预期女性的生活质量。临床上外科医生需充分平衡高危人群的获益与风险,采用多学科、个体化的方法辅助女性决策。

Prophylactic mastectomy has emerged in recent years as a method of reducing the risk of morbidity in women at high risk for breast cancer.The number of women in the United States who have undergone this surgery has surged over the past 20 years,and contralateral prophylactic mastectomy is more acceptable in patients with unilateral breast cancer than bilateral prophylactic mastectomy in high-risk healthy women.The decision-making for high-risk groups is based on multiple factors,including fear of cancer,concerns about breast symmetry and burden of screening.In high-risk healthy women,bilateral prophylactic mastectomy significantly reduces the risk and mortality of breast cancer,increases life expectancy,and demonstrates survival benefit.In patients with unilateral breast cancer,contralateral prophylactic mastectomy notably reduces the risk of developing contralateral breast cancer.Prophylactic mastectomy combined with breast reconstruction shows good cosmetic results and relieves the psychological stress of high-risk women,so women after surgery have a high level of overall satisfaction.However,there is an increased risk of postoperative complications such as tissue necrosis,infection,and bleeding,which may affect the quality of life.In clinical practice,surgeons need to adequately balance the benefits and risks in high-risk populations and adopt a multidisciplinary,individualized approach to assist women in their decision-making process.