肿瘤整形外科技术应用于早期乳腺癌保乳手术的临床分析

摘要

目的：探讨肿瘤整形技术应用于早期乳腺癌保乳术的近期疗效和美容效果。方法回顾性分析25例应用周围腺体组织瓣转位修复法或背阔肌肌皮瓣转位修复法行保乳术（观察组）和25例行传统保乳手术（对照组）患者的临床资料，比较两组患者的手术切除范围、切缘情况、RTOG美容等级评价、术后并发症及复发转移情况。结果观察组中21例行周围腺体组织瓣转位修复，4例行背阔肌皮瓣转位修复，切除乳腺体积为26～1105 cm3，中位体积343 cm3；对照组切除乳腺体积为15~504 cm3，中位体积262 cm3。术中冰冻病理示切缘阳性者观察组有3例，对照组5例，差异无统计学意义（χ2=0.504，P=0.478）。观察组和对照组美容等级评定为优或良的分别为22例（88%）和20例（80%），两组差异无统计学意义（χ2=0.611，P=0.737）。随访持续时间为2～12个月，中位随访时间为5个月，观察组中1例患者术后2个月出现多发骨转移，所有患者均未出现局部复发，无死亡病例。结论应用整形外科技术行保乳手术治疗早期乳腺癌在达到切缘无瘤累及的基础上，可获得更好的美容效果，且短期临床效果满意，值得进一步临床推广。%Objective To evaluate the short-term clinical effect and cosmetic outcome of oncoplastic techniques applied in breast-conserving surgery. Method Clinical data of 25 breast cancer patients who received breast-conserv-ing surgery with gland tissue flap or latissimus dorsi myocutaneous flap following breast reconstruction (observation group), and of another 25 patients that received traditional breast conservative surgery (control group) were retrospec-tively analyzed. The resection range, margin, RTOG cosmetic outcome evaluation, postoperative complications and re-currence or metastasis of the two groups were compared. Result Among the observation group, 21 cases received immediate breast reconstruction with adjacent gland tissue flap and 4 cases were with latissimus dorsi myocutaneous flap. The resection volume of the breast in observation group ranged from 26 to 1105 cm3, with a median volume of 343 cm3, while that of the control group ranged from 15 to 504 cm3, with a median volume of 262 cm3. And there were 3 cases in observation group, and 5 cases in control group that had positive surgical margins confirmed by intra-operative pathologic test of the frozen sections, while no significant differences were observed (χ2=0.504, P=0.478). As for RTOG cosmetic outcome evaluation, number of patients with excellent or good results were 22 (88%) and 20 (80%) in the observation group and control group, respectively, and there were still no significant differences between the two groups (χ2=0.611, P=0.737). One patient in the observation group had multiple bone metastasis in 2 months after surgery, and no recurrence or death was observed after a median follow-up of 5 months (range 2-12 months). Conclusion Application of plastic breast-conserving surgery in early breast cancer on the basis of negative surgical margins may bring about better cosmetic effect, with satisfactory short-term clinical outcome, making it an option that is worth further clinical practice.