保乳保腋窩手術治療T1期乳腺癌86例分析

史立波　王偉　于德海

[摘要]目的 觀察T1期乳腺癌行保乳保腋窩手術的治療效果。方法 回顧性分析2009年8月～2014年10月我院收治的86例行保乳保腋窩手術的T1期乳腺癌患者的臨床資料，觀察患者的手術并發癥、術后乳房美學效果及腫瘤大小與預后的關系。結果 86例患者的手術切口均Ⅰ期愈合，均無患肢淋巴水腫發生，術后乳房美學效果滿意度為96.5%（83/86）。腫瘤直徑≤1 cm組共40例（1組），前哨淋巴結陽性率為0（0/40）；1 cm<腫瘤直徑≤2 cm組共46例（2組），前哨淋巴結陽性率為15.2%（7/46），兩組患者的前哨淋巴結陽性率比較差異有統計學意義（P<0.05）。1組生存率略高于2組，但差異無統計學意義（P<0.05）。全部病例均隨訪，隨訪時間24～87個月，中位隨訪時間為50個月，均無復發及轉移。結論 保乳保腋窩手術治療T1期乳腺癌，效果好，并發癥少，值得臨床應用。

[關鍵詞]T1期乳腺癌；保乳保腋窩手術；前哨淋巴結；美學效果

[中圖分類號] R737.9 [文獻標識碼] A [文章編號] 1674-4721（2017）03（b）-0069-04

[Abstract]Objective The observe the therapeutic effect of breast and axillary reservation operation for stage T1 breast cancer.Methods The clinical data of 86 patients with stage T1 breast cancer who underwent breast and axillary reservation operation treated in our hospital form August 2009 to October 2014 were retrospectively analysed.The postoperative complications，the effect of breast aesthetics and the relationship between tumor size and prognosis were analyzed.Results Surgical incision in 86 patients with stage Ⅰ healing，no limb lymphedema，postoperative satisfaction effects on aesthetics of breast was 96.5% （83/86）.The tumor diameter less than 1 cm were 40 cases （group 1），the positive rate of sentinel lymph nodes was 0 （0/40）；tumor diameter more than 1 cm and less than 2 cm were 46 cases （group 2），the positive rate of sentinel lymph nodes was 15.2% （7/46）.There was significant difference in the positive rate of sentinel lymph node between two groups （P<0.05）.Further survival analysis showed that the survival rate of the group 1 was slightly higher than that of group 2，but the difference was not statistically significant （P<0.05）.All cases were followed up for 24-87 months，the median follow-up time of 50 months，and no recurrence and metastasis were found.Conclusion Breast and axillary reservation operation in the treatment of stage T1 breast cancer has good effect and few complications，which is worthy of clinical application.

[Key words]Stage T1 breast cancer；Breast and axillary reservation operation；Sentinel lymph node；Aesthetic effect

近些年來我國早期乳腺癌，尤其是T1期乳腺癌（腫瘤直徑≤2.0 cm）的發病率明顯升高，這主要歸功于人們自我保健意識的提高和臨床檢查技術的不斷改進[1-2]。目前保留乳房手術是治療T1期乳腺癌的主要手術方式，并為廣大醫界同仁認可[3-4]。關于保留乳房手術乳房缺損以及腋窩淋巴結的處理，目前仍有爭議。本文通過分析本院收治的86例行保乳保腋窩手術治療的T1期乳腺癌患者的臨床資料，觀察其臨床療效及安全性，現報道如下。

1資料與方法

1.1一般資料

選擇2009年8月～2014年10月本院收治的86例T1期乳腺癌并且成功實施了保乳保腋窩手術患者的臨床資料，所有患者均符合以下保乳手術指征：①腫瘤直徑≤2.0 cm；②腫瘤距乳暈邊緣≥2.0 cm；③乳腺鉬靶排除彌漫惡性鈣化，乳腺彩超或乳腺MRI排除乳房內多發癌灶；④乳房有適當的體積，一般 >200 ml；⑤術后有條件進行放療；⑥臨床評估腋窩淋巴結陰性；⑦除外炎性乳腺癌及妊娠哺乳期乳腺癌；⑧患者本人及家屬有強烈的保乳要求。本研究經過醫院醫學倫理委員會討論通過，所有患者均簽署手術知情同意書。