肿瘤整形技术在乳腺癌保乳手术中的临床应用

Clinical application of oncoplastic technique in breast-conserving surgery for breast cancer

背景与目的:整形保乳手术(OBCS)是在完整切除肿瘤病变的同时,应用整形技术对乳房进行整形修复,最大限度维持患者术后乳房的自然外形,从而提高患者的生活质量。然而,OBCS属于新兴技术,其效果与安全性的临床证据仍然有限。因此,本研究通过对OBCS与传统的保乳手术(TBCS)治疗早期乳腺癌相关临床指标的比较,进一步明确OBCS的疗效与安全性。方法:回顾性分析2015年1月—2020年1月在河南省新乡市中心医院肿瘤外科行乳腺癌保乳手术226例患者的临床资料和随访记录,其中95例行OBCS (OBCS组),131例行TBCS (TBCS组),对两组患者在手术相关指标、术后并发症发生率、术后乳房美容效果、患者主观满意度以及远期疗效等方面进行对评价。结果:OBCS组缺损修复方式包括腺体推进法47例,乳腺组织腺蒂瓣转位法22例,下蒂倒T形5例,翼状整形9例,腹腔大网膜充填3例,部分背阔肌及周围脂肪瓣3例,背阔肌肌瓣法4例,腹直肌带蒂肌皮瓣转移法2例。TBCS组均采用肿瘤局部扩大切除、残留腺体直接缝合法。OBCS组的手术时间明显长于TBCS组[(136.8±28.5) min vs.(75.2±22.3) min,P=0.002],但OBCS组术中切缘阳性再次扩大切除率明显低于TBCS组(3.2%vs. 11.5%,P=0.027)。OBCS组切除标本体积明显大于TBCS组[(101.3±12.9) mL vs.(67.6±9.8) mL,P=0.013];OBCS组术后乳房美容优良率明显高于TBCS组(86.3%vs. 37.4%,P=0.000);OBCS组患者主观满意率明显高于TBCS组(91.6%vs. 44.3%,P=0.000)。两组术中出血量、腋窝淋巴结清扫情况、术后并发症发生率、总住院时间、术后局部复发率、无瘤生存率及总生存率,差异均无统计学意义(均P>0.05)。结论:肿瘤整形技术应用于早期乳腺癌保乳手术,能够带来更佳的美容效果和更好的患者主观满意度,改善患者生活质量,且不会增加手术并发症和肿瘤复发、转移的发生风险,是值得推荐的一种临床技术。

Background and Aims:Oncoplastic breast-conserving surgery(OBCS) allows complete excision of tumors while maximally maintaining the natural breast contours,thereby improving the patients’ quality of life.However,OBCS is a newly emerging technique,the clinical evidence of its efficacy and safety is still limited.Therefore,this study was conducted to further determine the clinical efficacy and safety of OBCS through comparing the relevant clinical variables between OBCS and traditional breastconserving surgery(TBCS) in the treratment of early breast cancer.Methods:The clinical data and follow-up records of 226 patients who underwent breast-conserving surgery for breast cancer in the Department of Oncology Surgery of Xinxiang Central Hospital from January 2015 to January 2020 were retrospectively analyzed.Of the patients,95 cases underwent OBCS(OBCS group) and 131 cases were subjected to TBCS(TBCS group).The clinical variables that included the operation-related indexes,incidence of postoperative complications,postoperative cosmetic outcomes,patients’ subjective satisfaction and long-term efficacy between the two groups of patients were compared and evaluated.Results:In OBCS group,the defect closure methods included glandular advancement in 47 cases,transposition flap placement in 22 cases,inverted-T mammoplasty in 5 cases,bat-wing technique in 9 cases,pedicled omental flap reconstruction in 3 cases,partial latissimus dorsi added fat flap reconstruction in 3 cases,latissimus dorsi flap reconstruction in 4 cases,and rectus abdominis flap transposition in 2 cases.In TBCS group,the extended local excision of the tumor was performed in all patients,followed by direct residual gland suture.The operative time in OBCS group was significantly longer than that in OBCS group [(136.8±28.5) min vs.(75.2±22.3) min,P=0.002],but the rate of intraoperative second extended resection for positive margin in OBCS group was significantly lower than that in TBCS group(3.2% vs.11.5%,P=0.027).The volume of resected specimen in OBCS group was significantly larger than that in TBCS group [(101.3±12.9) mL vs.(67.6±9.8) mL,P=0.013].The excellent and good rate of breast cosmetic effect in OBCS group was significantly higher than that in TBCS group(86.3% vs.37.4%,P=0.000).The subjective satisfaction rate in OBCS group was significantly higher than that in TBCS group(91.6% vs.44.3%,P=0.000).There were no significant differences in intraoperative blood loss,axillary lymph node dissection,incidence of postoperative complications,total length of hospital stay,postoperative local recurrence rate,disease-free survival rate and overall survival rate between the two groups(all P>0.05).Conclusion:The application of oncoplastic surgery in breast-conserving surgery for appropriate breast cancer patients can offer better cosmetic effect and better subjective satisfaction,improve the patients’ quality of life without increase of the risk of complications as well as tumor recurrence and metastasis.So,it is recommended to be used in clinical parctice.