中央区乳腺癌保乳治疗可行性的临床观察

既往研究业已证明,乳腺癌保乳治疗与切除乳房治疗生存率无显著差异[1].但在保乳治疗适应证和禁忌证的掌握方面,尽管肿瘤距乳头乳晕区(NAC)2.0 cm以内的乳腺癌(简称中央区乳腺癌)患者未被列入保乳治疗的绝对禁忌证,但多数学者仍认为是相对禁忌证,因此中央区乳腺癌保乳治疗罕见报道.2002年10月至2009年10月我科共开展各种保乳手术200例,其中中央区乳腺癌患者80例,取得良好疗效,现报告如下.     

乳腺癌保乳手术治疗148例分析

目的研究乳腺癌保乳治疗方法的选择,探讨保乳手术适应证及疗效. 方法回顾分析1996年1月～2003年10月我院接受保乳治疗的148例乳腺癌临床资料.0期5例,Ⅰ期85例,Ⅱ期55例,Ⅲ期3例.手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清扫.术后常规行辅助放疗、化疗和内分泌治疗. 结果手术标本石蜡病理检查各切缘均无癌浸润.经过54个月中位随访期(范围2～84个月),局部复发率为2.7%(4/148),其中乳腺3例,腋窝1例;远处转移率3.4%(5/148),手术至远处转移间期6～43个月,转移部位分别为肺、肝、脑膜和骨,其中3例死亡.对保乳综合治疗结束后满1年的108例患者进行乳房外形的评估,优32.4%(35/108),良49.1%(53/108),差18.5%(20/108). 结论对早期乳腺癌及部分经新辅助化疗降期后的局部进展期乳腺癌进行保乳手术治疗效果满意.规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键.保乳手术后大部分患者乳房外形良好.     

95例乳腺癌保乳治疗近期观察

目的探讨乳腺癌保乳治疗的方法与疗效。方法95例Ⅰ-Ⅱ期原发性乳腺癌,施行局部扩大切除并腋窝淋巴结清扫,手术后患侧乳房接受放射治疗。结果手术后6个月随访,患者本人对保留乳房的满意率100％,十分满意者为92％。经随访2～51个月,平均随访17个月,仅1例同侧乳腺局部复发,2年局部复发率1．4％。无远处转移和死亡病例。结论Ⅰ-Ⅱ期乳腺癌实施保乳治疗,近期疗效满意,远期效果有待长期随访观察。     

经乳晕保乳手术联合常规腋窝淋巴结清扫治疗乳腺癌

目的探讨经乳晕或乳腔镜辅助保乳手术联合常规腋窝淋巴结清扫治疗乳腺癌的效果. 方法 2001年8月～2003年11月,对19例直径<2 cm、距离乳头>2 cm的乳腺癌经乳晕或乳腔镜辅助行保乳手术,腋窝脂肪溶解抽吸后常规开放性腋窝淋巴结清扫. 结果 1例术中冰冻病理报告一侧切缘镜下癌残留,经扩大切除后转阴.术后2例乳房创面皮下积液,抽洗加压包扎消失.保留的乳房形态良好,伤口小而隐蔽,所有患者对手术效果满意.术后随访2～19个月,平均10.6月,未见乳腺和腋窝肿瘤复发. 结论经乳晕或乳腔镜辅助下,借助乳腔镜器械可以方便地完成乳腺癌保乳手术,联合常规腋窝淋巴结清扫,手术效果肯定.     

早期老年乳腺癌的保乳治疗

目的总结早期老年乳腺癌保乳治疗的临床疗效。方法保乳手术治疗23例早期老年乳腺癌患者,其中Ⅰ期7例,ⅡA期12例,ⅡB期4例,术中切除距肿块边缘2 cm以上乳腺,术后予放疗、化疗及激素治疗。结果随访3.5（2～5）年,未见复发及远处转移。采用Harris提出的四等分类法为美容评定标准,佳4例（17.4%）,良16例（69.6%）,一般2例（8.7%）,差1例（4.3%）,总优良率87.0%。结论保乳治疗早期老年乳腺癌具有机体创伤小、组织器官破坏少、美容效果好和保存功能的优点,在严格掌握手术适应证的前提下,并不增加复发及远处转移的风险。     

乳腺癌保乳手术中、远期疗效的临床评价

目的探讨早期乳腺癌保乳治疗的中、远期临床疗效。方法观察52例Ⅰ、Ⅱ期原发性乳腺癌患者，51例施行保乳切除并腋窝淋巴结清扫，术后辅以化疗、放疗、内分泌等综合治疗，另外1例因二次切缘阳性而行改良根治术。结果保乳手术局部复发率和远处转移率分别为5．9％、3．9％，3、5年生存率分别为96．08％、92．16％。患者对残乳自我评价的满意程度为82．4％（42／51），其中良好者占58．8％（30／51）。结论保乳手术联合术后辅助放疗和全身化疗治疗早期乳腺癌安全可行。     

早期乳腺癌保乳手术52例分析

目的评估早期乳腺癌保乳综合治疗的疗效。方法2000年3月～2005年9月，我院对52例Ⅰ期及部分Ⅱ期（肿瘤≤3cm，单发病灶）乳腺癌行局部广泛切除术，全腋窝淋巴结清扫术联合术后放疗，并辅以化疗（CMF或CEF方案）、内分泌治疗（口服三苯氧胺）。结果术后病理提示个切缘无癌细胞浸润。美容效果优良率达86．5％（45／52）。50例随访10～36个月（中位时间16个月），未见局部复发与远处转移。结论选择部分Ⅰ～Ⅱ期乳腺癌病例行保乳手术治疗，乳房外形及临床疗效满意，而且可以提高生活质量。     

早期乳腺癌保乳手术247例报告

目的：探讨早期乳腺癌保乳手术的技巧和近期疗效。方法：1995年-2004年收治女性乳腺癌2548例，选择临床0～Ⅱa期、非乳晕区单发肿瘤247例施行保乳手术。对肿瘤直径〈2cm者，行肿瘤局部扩大切除；对肿瘤直径2～3cm者则行象限切除，切缘行冰冻检查，常规腋淋巴结清扫。乳晕部残留腺体作阶梯状对缝。术后胸壁行50Gy放疗，瘤床追加10Gv放疗。腋窝淋巴结阳性及高危病人接受化疗；雌激素受体阳性者接受内分泌治疗。结果：247例手术全部成功，无并发症发生。总保乳率9．7％（247／2548），占同期乳腺癌保乳率22．6％，美容满意率达93．6％。平均随访69个月，随访率74．1％（183／247例）。局部复发率1．63％（3／183例），腋淋巴结复发率1．09％（2／183例），复发时间为术后3年2个月：远处转移率1．09％（2／183例），术后4年半1例肺转移，1例肝转移；随访期中，死亡3例，1例死因为心肌梗死，2例为肺、肝转移；5年无病生存率95．6％（175／183例），总生存率98．4％（180／183例）。结论：乳腺癌保乳手术近期总疗效属满意。     

乳腺癌保乳手术疗效观察

目的探讨保乳手术治疗Ⅰ～Ⅱ期乳腺癌的临床应用价值。方法回顾我院从1997年7月-2007年6月收治Ⅰ～Ⅱ期乳腺癌109例，施行保乳手术46例，同期完成改良根治手术63例，术后辅助放、化疗和内分泌治疗。结果保乳患者术后并发症发生率低（P〈0．05），局部复发转移率无统计学差异（P〉0．05）。结论保乳手术有利于提高患者生活质量和社会交往信心，值得临床推广。     

早期乳腺癌保乳治疗32例疗效分析

目的探讨Ⅰ、Ⅱ期乳腺癌保乳综合治疗的疗效及相关技术,为普及早期乳腺癌保乳综合治疗提供参考。方法回顾性分析2003年2月～2010年12月32例行保乳手术治疗乳腺癌患者的相关资料,对肿瘤采取局部扩大切除并进行腋窝淋巴结清扫,术后辅以放疗、化疗或内分泌治疗。结果所有患者随访12～82个月,无局部复发及远处转移,乳房美容评定标准进行评价,符合优良标准31例（96.9%）,符合差标准1例（3.1%）。结论早期乳腺癌保乳综合治疗创伤小、疗效确切、形体改变少、能提高生存质量,值得进一步临床开展及推广。     

Central quadrantectomy with resection of the nipple-areola complex compared with mastectomy in patients with retroareolar breast cancer

Appropriate surgery in women with retroareolar breast cancer should allow resection of the cancer with wide free margins and an acceptable cosmetic result. The aim of this study was to compare breast conservation surgery (BCS) to mastectomy for treatment of retroareolar breast cancer. In a prospective nonrandomized study, 69 women with retroareolar breast cancers underwent either central quadrantectomy (n=33) with complete removal of the nipple-areola complex or mastectomy (n=36). Two of 33 (6%) patients scheduled for BCS had a secondary mastectomy and immediate reconstruction due to involved margins. After a median follow-up of 42 month (range 17-99 months) in the BCS group and 43 months (range 16-118 months) in the mastectomy group local and regional recurrences as well as systemic disease were comparable between both groups. The postoperative cosmetic result after BCS as evaluated by the patients was rated as excellent in 80% and good in 20% with no poor result. BCS followed by radiation therapy is a feasible alternative to mastectomy in patients with retroareolar breast cancer.     

Follow-up of two treatment modalities for ductal cancer in situ of the breast

In a mammography screening programme for the early detection of breast cancer 66 cases of ductal cancer in situ of the breast (DCIS) were diagnosed between 1978 and 1984 and prospectively followed up. In the beginning of the study period, DCIS was treated by mastectomy without axillary clearance but sector resection has been performed increasingly. Since 1982 the latter procedure has become standard treatment. Radical resection was confirmed by specimen X-ray and histopathological examination of whole organ sections. No postoperative radiotherapy was given. Twenty-eight women had mastectomy and 38 had sector resection. The median follow-up times were 77 and 60 months respectively. In the mastectomy group postoperative monitoring did not reveal any local recurrence but one contralateral new invasive cancer was discovered. In the sector resection group five recurrences were found. Three of the latter were new cases of DCIS and two appeared as small invasive cancers (stage I). Mastectomy will cure ductal cancer in situ but has a greater morbidity. Sector resection has been established as the method of choice in stage I invasive cancer and is probably also safe in DCIS. The possible beneficial effect of postoperative local radiotherapy after sector resection for DCIS is currently being analysed in a randomized trial which started in Sweden in 1987.     

早期乳腺癌保乳手术探讨

目的 探讨早期乳腺癌保乳手术加放疗治疗效果.方法 分析近6年76例保乳术后加放疗的乳腺癌病人临床资料.结果 76例患者3,5年生存率分别为96.05%,94.8%;3,5年局部复发率分别为5.3%,6.6%;术后3,5年乳房保留率分别为96.05%,93.3%;仅1例胸壁复发,无死亡病例.该复发病例25岁,未婚,保乳愿望强烈,复发后再次行乳房切除及化疗,现健在.术后形体美容效果满意度80.5%.结论 早期乳腺癌采用保乳手术及放射治疗可取得满意结果,规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键.     

Conservative treatment of the central breast cancer with nipple-areolar resection: an alternative oncoplastic technique

Conservative surgery with radiation therapy is the standard treatment for early-stage breast cancer. Nevertheless, the patients with subareolar breast cancer have been often excluded from breast-conserving surgery and treated with mastectomy because of the unacceptable cosmetic effect associated with the resection of the nipple-areola complex (NAC), as well as oncologic concerns about multicentricity or multifocality associated with these tumours. We show a conservative "oncoplastic technique" in which the resection of the central portion of the breast, including the NAC, can allow a wide excision of the tumour with uninvolved margins of resection and good cosmetic results.     

高龄早期乳腺癌的治疗经验(病例报道及文献复习)

总结我科最近一例高龄早期乳腺癌患者的临床资料,通过多学科治疗团队分析高龄早期乳腺癌的麻醉方式、手术、辅助放疗、辅助化疗及内分泌治疗对患者影响制定治疗方案,最终在在利多卡因局部浸润麻醉下顺利接受左乳癌保乳术,术后10天愈合。术后病理:左乳浸润性乳头状癌,直径约4 cm,前哨淋巴结阴性,ER(95%+),PR(95%+),HER-2(0),Ki-67(20%+)。术后未接受辅助放疗及全身系统辅助治疗。多学科治疗团队治疗前评估高龄乳腺癌治疗获益及风险,可为高龄乳腺癌患者制定明确安全且可靠的治疗方案。     

Role of conservation therapy for invasive lobular carcinoma of the breast

Background: Invasive lobular carcinoma (ILC) accounts for 5% to 10% of all invasive breast cancers. Although breast conservation therapy using local excision and postoperative irradiation is a standard therapy for early invasive ductal breast cancer, the result of this strategy in ILC is not well documented. We sought to determine the rate of locoregional recurrence after breast conservation therapy in patients with ILC. Methods: A retrospective review of 74 patients with ILC treated with breast conservation therapy at The University of Texas M. D. Anderson Cancer Center (n=43) or The John Wayne Cancer Institute (n=31) between 1977 and 1993 was performed. Results: The median age of patients was 60 years, and median follow-up was 56 months (range 1 to 207 months). Thirty-nine patients had American Joint Committee on Cancer stage I disease, 30 had stage IIa disease, and five had stage IIb disease. All patients underwent surgical resection and postoperative radiation therapy. Twelve patients received postoperative adjuvant chemotherapy, and 27 patients were treated with adjuvant hormonal therapy. The 5-year actuarial locoregional recurrence rate was 9.8%, and the median time to recurrence was 77 months (range 41 to 113 months). Patients with positive or close (⩽1 mm) surgical margins were at increased risk for local recurrence on univariate analysis (p=0.034). Of the nine patients with breast recurrence, six underwent salvage therapy with total mastectomy and are disease free at the time of this writing, two patients died of distant disease, and one is alive with local disease at the time of this report. The 5-year disease-specific survival rate was 93.7%. Conclusions: Breast conservation therapy for ILC achieves locoregional control in the majority of patients. However, long-term follow-up of patients is important because many local recurrences following breast conservation therapy are late events. Presented at the 50th Annual Cancer Symposium of the Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

保留乳头乳晕复合体乳腺癌根治即刻胸大肌包裹假体植入乳房重建

目的 探讨保留乳头乳晕复合体(NAC)的乳腺癌改良根治术即刻胸大肌包裹假体植入乳房重建的可行性.方法 对28例0、I、II期乳腺癌行保留皮肤的乳腺癌改良根治术后,即刻于胸大肌后方植入硅胶假体重建乳房,并根据冰冻切片结果决定是否保留NAC.结果 28例早期乳腺癌均保留了NAC,术后随访2～18个月(中位随访期:15个月),外观良好,双侧乳房对称,优良率达96.5%;均无局部复发或远处转移,无明显术后并发症.结论 保留NAC的乳腺癌改良根治术后用硅胶假体行即刻乳房重建,能达到满意的乳房美容效果,是治疗早期乳腺癌安全可行的方法.     

Breast conservation surgery using nipple-areolar resection for central breast cancers

HYPOTHESIS: Resection of the nipple-areolar complex (NAC) for central breast cancers that involve the nipple or areola, with postoperative radiation therapy, adheres to the oncologic principles established for breast conservation surgery of other breast cancers. Good or excellent cosmetic results can be achieved. The rate of ipsilateral breast recurrence will be similar to that seen with peripheral breast cancers. The indications for breast conservation surgery can be safely extended to include patients with breast cancers that involve the NAC. DESIGN: Retrospective medical record review; follow-up patient questionnaire. SETTING: Community teaching hospital. PATIENTS: Fifteen patients, aged 46 to 88 years, whose central breast cancers involved the NAC precluding preservation of the NAC. INTERVENTIONS: Nipple-areolar complex resection, postoperative radiation therapy. MAIN OUTCOME MEASURES: Ipsilateral breast recurrence, survival, cosmesis. RESULTS: Ten patients had subareolar cancers that directly involved the nipple or areola; 5 patients had Paget disease of the nipple. Average tumor size was 1.6 cm (range, 0.2-3.5 cm). With a mean follow-up of 32 months (range, 4-109 months), there has been only 1 recurrence (7%), which was treated successfully by modified radical mastectomy. All 15 patients are alive and free of disease. Cosmetic results are satisfactory to excellent, as judged by both the patients and the surgeons. CONCLUSIONS: Nipple-areolar complex resection for central subareolar cancers that directly involve the NAC, as well as for Paget disease of the nipple, extends the indications for breast conservation in other areas of the breast, and with acceptable cosmesis.     

探讨联合应用脂肪抽吸和小切口腺体切除治疗男性乳腺发育的临床意义

目的探讨联合应用脂肪抽吸加乳晕小切口腺体切除治疗男性乳腺发育的临床意义。方法联合应用脂肪抽吸加小切口腺体切除治疗男性乳腺发育30例,首先应用脂肪抽吸术在腺体的前后两平面将乳腺前后脂肪吸出,同时在腺体前后两层形成两个已剥离的、潜在的平面,然后通过乳晕下小切口切除腺体。结果本组单侧乳房腺体切除平均133(20~200)g,脂肪组织抽吸量平均650(250~1 000)ml,术中出血平均43(20~80)m l。乳晕切口长约2 cm,均为甲级愈合。本组均无血肿、血清肿、乳头乳晕坏死、感染等并发症发生。随访6~12个月无复发,患者均获得平整的胸廓外形,无乳头乳晕凹陷。结论脂肪抽吸加小切口腺体切除治疗男性乳腺发育,方法简单,出血少、术后胸部平整,效果理想。