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(shù)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(shù)的T1期乳腺癌患者的臨床資料，觀察患者的手術(shù)并發(fā)癥、術(shù)后乳房美學(xué)效果及腫瘤大小與預(yù)后的關(guān)系。結(jié)果 86例患者的手術(shù)切口均Ⅰ期愈合，均無患肢淋巴水腫發(fā)生，術(shù)后乳房美學(xué)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(jié)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(jié)陽性率為15.2%（7/46），兩組患者的前哨淋巴結(jié)陽性率比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。1組生存率略高于2組，但差異無統(tǒng)計(jì)學(xué)意義（P<0.05）。全部病例均隨訪，隨訪時(shí)間24～87個(gè)月，中位隨訪時(shí)間為50個(gè)月，均無復(fù)發(fā)及轉(zhuǎn)移。結(jié)論 保乳保腋窩手術(shù)治療T1期乳腺癌，效果好，并發(fā)癥少，值得臨床應(yīng)用。

[關(guān)鍵詞]T1期乳腺癌；保乳保腋窩手術(shù)；前哨淋巴結(jié)；美學(xué)效果

[中圖分類號(hào)] R737.9 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 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(guó)早期乳腺癌，尤其是T1期乳腺癌（腫瘤直徑≤2.0 cm）的發(fā)病率明顯升高，這主要?dú)w功于人們自我保健意識(shí)的提高和臨床檢查技術(shù)的不斷改進(jìn)[1-2]。目前保留乳房手術(shù)是治療T1期乳腺癌的主要手術(shù)方式，并為廣大醫(yī)界同仁認(rèn)可[3-4]。關(guān)于保留乳房手術(shù)乳房缺損以及腋窩淋巴結(jié)的處理，目前仍有爭(zhēng)議。本文通過分析本院收治的86例行保乳保腋窩手術(shù)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(xiàn)報(bào)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(shí)施了保乳保腋窩手術(shù)患者的臨床資料，所有患者均符合以下保乳手術(shù)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M(fèi)RI排除乳房?jī)?nèi)多發(fā)癌灶；④乳房有適當(dāng)?shù)捏w積，一般 >200 ml；⑤術(shù)后有條件進(jìn)行放療；⑥臨床評(píng)估腋窩淋巴結(jié)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(qiáng)烈的保乳要求。本研究經(jīng)過醫(yī)院醫(yī)學(xué)倫理委員會(huì)討論通過，所有患者均簽署手術(shù)知情同意書。