保乳保腋窝手术治疗T1期乳腺癌86例分析

史立波　王伟　于德海

[摘要]目的 观察T1期乳腺癌行保乳保腋窝手术的治疗效果。方法 回顾性分析2009年8月～2014年10月我院收治的86例行保乳保腋窝手术的T1期乳腺癌患者的临床资料，观察患者的手术并发症、术后乳房美学效果及肿瘤大小与预后的关系。结果 86例患者的手术切口均Ⅰ期愈合，均无患肢淋巴水肿发生，术后乳房美学效果满意度为96.5%（83/86）。肿瘤直径≤1 cm组共40例（1组），前哨淋巴结阳性率为0（0/40）；1 cm<肿瘤直径≤2 cm组共46例（2组），前哨淋巴结阳性率为15.2%（7/46），两组患者的前哨淋巴结阳性率比较差异有统计学意义（P<0.05）。1组生存率略高于2组，但差异无统计学意义（P<0.05）。全部病例均随访，随访时间24～87个月，中位随访时间为50个月，均无复发及转移。结论 保乳保腋窝手术治疗T1期乳腺癌，效果好，并发症少，值得临床应用。

[关键词]T1期乳腺癌；保乳保腋窝手术；前哨淋巴结；美学效果

[中图分类号] R737.9 [文献标识码] A [文章编号] 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

近些年來我国早期乳腺癌，尤其是T1期乳腺癌（肿瘤直径≤2.0 cm）的发病率明显升高，这主要归功于人们自我保健意识的提高和临床检查技术的不断改进[1-2]。目前保留乳房手术是治疗T1期乳腺癌的主要手术方式，并为广大医界同仁认可[3-4]。关于保留乳房手术乳房缺损以及腋窝淋巴结的处理，目前仍有争议。本文通过分析本院收治的86例行保乳保腋窝手术治疗的T1期乳腺癌患者的临床资料，观察其临床疗效及安全性，现报道如下。

1资料与方法

1.1一般资料

选择2009年8月～2014年10月本院收治的86例T1期乳腺癌并且成功实施了保乳保腋窝手术患者的临床资料，所有患者均符合以下保乳手术指征：①肿瘤直径≤2.0 cm；②肿瘤距乳晕边缘≥2.0 cm；③乳腺钼靶排除弥漫恶性钙化，乳腺彩超或乳腺MRI排除乳房内多发癌灶；④乳房有适当的体积，一般 >200 ml；⑤术后有条件进行放疗；⑥临床评估腋窝淋巴结阴性；⑦除外炎性乳腺癌及妊娠哺乳期乳腺癌；⑧患者本人及家属有强烈的保乳要求。本研究经过医院医学伦理委员会讨论通过，所有患者均签署手术知情同意书。