开展中国乳腺外科腔镜手术多中心研究的思考

Thoughts on Multi-center Research endoscopic breast surgery in China

乳腺癌是女性最常见的恶性肿瘤,治疗原则是以手术为主的综合治疗。随着腔镜技术为主的微创外科的发展以及对乳腺癌治疗理念的转变和医患对术后高生存质量的追求,腔镜手术也被越来越多的乳腺外科医生接受。前期对乳腺腔镜手术的研究表明其临床疗效同常规手术相当,具有安全性及可行性,实现了在治疗疾病的同时让患者拥有更高的生存质量。但乳腔镜的研究大多为单中心、小样本、回顾性研究,证据等级低,缺乏大规模多中心前瞻性研究。因此,腔镜技术的安全性及疗效仍存在着争议,有必要开展多中心、大样本、前瞻性研究来证实其可行性及安全性。而乳腺腔镜手术与腹腔镜手术不同,不同单位或中心的手术建腔方式、入路等多种多样,如何能开展好合适的多中心研究值得探讨。

Breast cancer is the most common malignant tumor in women,and the treatment principle is comprehensive treatment based on surgery.With the development of minimally invasive technology including endoscopic surgery,the transformation of breast cancer treatment strategy and pursuit of high quality of life after surgery,endoscopic surgery is accepted by more and more breast surgeons.Earlier studies on breast endoscopic surgery have shown that its clinical efficacy is equivalent to conventional surgery,with high safety and feasibility,which enables patients to have a higher quality of life while treating diseases.However,most of the studies on endoscopic surgery for breast cancer are single-center,small-sample,retrospective studies,with low levels of evidence and lack of large-scale multicenter prospective studies.Therefore,the safety and efficacy of endoscopy are still controversial,and it is necessary to carry out multi-center,large-sample,prospective studies to verify its feasibility and safety.Unlike laparoscopic surgery,the surgical approaches and the ways to establish a cavity during breast endoscopic surgery may be different in different breast centers.How to carry out a multi-center research appropriately is worth discussing.