中华普外科手术学杂志（电子版）
中華普外科手術學雜誌（電子版）
중화보외과수술학잡지（전자판）
CHINESE JOURNAL OF OPERATIVE PROCEDURES OF GENERAL SURGERY(ELECTRONIC VERSION)
2008年
2期
168-175
,共8页
刘岩松%王永胜%孙敏%周正波%李永清%王磊%刘雁冰%李济宇%赵桐%陈鹏
劉巖鬆%王永勝%孫敏%週正波%李永清%王磊%劉雁冰%李濟宇%趙桐%陳鵬
류암송%왕영성%손민%주정파%리영청%왕뢰%류안빙%리제우%조동%진붕
乳腺肿瘤%乳房切除术%肿瘤复发,局部
乳腺腫瘤%乳房切除術%腫瘤複髮,跼部
유선종류%유방절제술%종류복발,국부
Breast neoplasms%Mastectomy%Neoplasm recurrence,local
目的 探讨对临床Ⅰ、Ⅱ期乳腺癌患者选择性行乳腺癌保留乳房治疗(BCT)的远期生存、同侧乳房复发(IBR)、美容效果及其相关因素.方法 1985年10月至2007年12月共对680例临床Ⅰ、Ⅱ期乳腺癌开展BCT临床研究.乳腺癌保乳手术先后采用乳腺象限/区段切除术及肿瘤扩大切除术,联合全腋淋巴结清扫术或前哨淋巴结活检术.术后放疗先后采用Co60及加速器全乳放疗及瘤床缩野照射.结果 中位随访10年,680例BCT患者10年总生存率IBR 83.7%、同侧乳房复发为8.5%、远处转移率为23.7%.患者年龄、肿瘤大小、病理组织学类型、腋淋巴结转移状况等临床病理因素对BCT后IBR差异无统计学意义(均P>0.05);切缘阳性、术后未行全乳照射的患者IBR显著升高(均P=0.000).在确保切缘阴性的前提下,不同切除范围的手术方式对IBR差异无统计学意义(P=0.799),但切除范围较大的区段/象限切除术对BCT后乳房美容效果差异有统计学意义(优秀组P=0.043,优秀+良好组P=0.005).结论 临床Ⅰ、Ⅱ期乳腺癌选择性行BCT有较好的远期疗效、较好的美容效果和较低的IBR,可以安全地替代乳房切除性手术;确保切缘阴性及接受术后全乳放疗仍是现阶段乳腺癌BCT的金标准;在确保切缘阴性的前提下,切除范围较小的肿瘤扩大切除术有较好的美容效果和相同的治疗效果.
目的 探討對臨床Ⅰ、Ⅱ期乳腺癌患者選擇性行乳腺癌保留乳房治療(BCT)的遠期生存、同側乳房複髮(IBR)、美容效果及其相關因素.方法 1985年10月至2007年12月共對680例臨床Ⅰ、Ⅱ期乳腺癌開展BCT臨床研究.乳腺癌保乳手術先後採用乳腺象限/區段切除術及腫瘤擴大切除術,聯閤全腋淋巴結清掃術或前哨淋巴結活檢術.術後放療先後採用Co60及加速器全乳放療及瘤床縮野照射.結果 中位隨訪10年,680例BCT患者10年總生存率IBR 83.7%、同側乳房複髮為8.5%、遠處轉移率為23.7%.患者年齡、腫瘤大小、病理組織學類型、腋淋巴結轉移狀況等臨床病理因素對BCT後IBR差異無統計學意義(均P>0.05);切緣暘性、術後未行全乳照射的患者IBR顯著升高(均P=0.000).在確保切緣陰性的前提下,不同切除範圍的手術方式對IBR差異無統計學意義(P=0.799),但切除範圍較大的區段/象限切除術對BCT後乳房美容效果差異有統計學意義(優秀組P=0.043,優秀+良好組P=0.005).結論 臨床Ⅰ、Ⅱ期乳腺癌選擇性行BCT有較好的遠期療效、較好的美容效果和較低的IBR,可以安全地替代乳房切除性手術;確保切緣陰性及接受術後全乳放療仍是現階段乳腺癌BCT的金標準;在確保切緣陰性的前提下,切除範圍較小的腫瘤擴大切除術有較好的美容效果和相同的治療效果.
목적 탐토대림상Ⅰ、Ⅱ기유선암환자선택성행유선암보류유방치료(BCT)적원기생존、동측유방복발(IBR)、미용효과급기상관인소.방법 1985년10월지2007년12월공대680례림상Ⅰ、Ⅱ기유선암개전BCT림상연구.유선암보유수술선후채용유선상한/구단절제술급종류확대절제술,연합전액림파결청소술혹전초림파결활검술.술후방료선후채용Co60급가속기전유방료급류상축야조사.결과 중위수방10년,680례BCT환자10년총생존솔IBR 83.7%、동측유방복발위8.5%、원처전이솔위23.7%.환자년령、종류대소、병리조직학류형、액림파결전이상황등림상병리인소대BCT후IBR차이무통계학의의(균P>0.05);절연양성、술후미행전유조사적환자IBR현저승고(균P=0.000).재학보절연음성적전제하,불동절제범위적수술방식대IBR차이무통계학의의(P=0.799),단절제범위교대적구단/상한절제술대BCT후유방미용효과차이유통계학의의(우수조P=0.043,우수+량호조P=0.005).결론 림상Ⅰ、Ⅱ기유선암선택성행BCT유교호적원기료효、교호적미용효과화교저적IBR,가이안전지체대유방절제성수술;학보절연음성급접수술후전유방료잉시현계단유선암BCT적금표준;재학보절연음성적전제하,절제범위교소적종류확대절제술유교호적미용효과화상동적치료효과.
Objective To evaluate the survival, ipsilateral breast recurrence (IBR) and cosmetic results of breast conserved therapy (BCT) for stage I and II breast cancer. Methods From Oct. 1985 to Dec. 2007, BCT was performed in 680 patients with stage I and II breast cancer. Breast conserved surgery included quadrantectomy, sector resection, and lumpectomy, combined with whole axillary lymph node dissection. Co60 and accelerator were used for whole breast and boast irradiation. Results With median follow up of 10 years, the overall survival, IBR, and distant recurrence rates were 83.7%, 8.5%, and 23.7%, respectively. Patient age, tumor size, histopathological type, and axillary node status had no relatunship with IBR (P>0.05), IBR was significant higher in patients with positive margin and without irradiation (P=0.000 for both). With a clear margin, there was no difference of IBR between quadrantectomy/sector resection and lumpectomy (P=0.799), but the former had poor cosmetic results (P<0.05). Conclusions With excellent longterm survival, IBR, and cosmetic results, BCT could safely replace mastectomy in patients with stage I and II breast cancer; Clear margin and whole breast irradiation are still gold stand ards for BCT at present; Lumpectomy has better cosmetic results and same curative effect compared to quadrantectomy/sector resection.
