保留乳房手术在早期乳腺癌治疗中的应用

目的：研究规范病例的选择、手术的范围及术后辅助治疗的方式，使早期乳腺癌的保乳治疗取得良好的局部控制水平、生存率及生活质量。方法：1995年10月-2000年2月，对78例早期乳腺癌病例实施了保乳治疗。手术指征：肿瘤最大直径≥3cm，周围型肿块，年龄≤65岁，病人有保留乳房的意愿，乳房足够大，以保证术后有良好的外形。手术方式为肿块广泛切除加腋淋巴结清扫；肿块位于乳腺外上象限者，原发灶与腋窝行整块切除。术后常规行辅助放疗及化疗。结果：手术标本各个切缘的组织病理切片检查未发现肿瘤累及。13例为导管内癌，9例特殊型浸润性癌，56例为浸润性导管癌；8例患者腋淋巴结发现癌转移，中位淋巴结转移个数为3个（1-8）。中位随访时间22个月。尚无局部及区域复发的病例。有1例远处转移，转移部位是胸膜，手术至转移期间30个月。对40名保乳治疗满一年的病例行乳房外形的随访，两侧乳头水平高度相差＞3cm有7例（17.5%)，两侧乳房下皱褶水平高度相差＞3cm有3例（7.5%)，两侧乳头与胸骨中线距离相差＞1.5cm有2例（5%）。结论：规范的广泛切除、腋淋巴结清扫及术后辅助放疗是早期乳腺癌保乳治疗的关键措施，可使局部复发率降低；同时保乳治疗后大多数病例能够保持良好的乳房外形。

Breast-conserving therapy for patients with early stage breast carcinoma

Purpose：To ensure good survival rate and quality of life for early stage breast cancer patients, we standardized the eligibility of breast conservation, the range of resection and post-operative adjuvant management.Methods：During October 1995 to Feburary 2000, 78 early stage breast carcinoma patients received breast-conserving treatment in our hospital. The eligibility of patients is: patients with peripheral breast tumor measuring up to 3 cm in the maximum diameter at clinical examination, and they were under 65 and desired to preserve their breast. Treatment of the primary was wide exision of tumor and axillary lymph node dissection. When the primary carcinoma was located in the upper-outer quadrant, quadrantectomy and axillary dissection were done en bloc. Adjuvant irradiation and chemotherapy was given postoperatively.Results：All the breast specimens were examined and no positive margins were found. 13 cases were ductal carcinoma in situ(DCIS), 8 cases were special type infiltrative carcinoma, and 56 cases were infiltrative ductal carcinoma. 8 patients were axillary lymph node positive, the median of positive nodes was 3(1—8). The median time of follow up was 22 months. There was no local reccurence in our group. Distant metastasis occurred in 1 case, and the site of metastasis was pleura, the time of appearance from surgery was 30 months. 40 patients, who received breast preserving treatment 12 months previously, were evaluated for cosmetic results. We found 7 cases(18%) with >3 cm in height between nipples, 3 cases (8%) with > 3cm in height between inferior profiles of breasts, and 2 cases(5%) with >1.5 cm in length between median line and nipples. Conclusions：For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant radiotherapy lead to excellent local control and good cosmetic results.