乳腺癌保留乳房治疗后乳房美容效果的影响因素探讨

目的回顾性分析早期乳腺癌患者保留乳房治疗后影响美容效果的相关因素。方法本院于1999年11月至2008年12月对162例临床0、Ⅰ、ⅡA期的乳腺癌患者实施保留乳房治疗，将乳头横向移位距离、乳头纵向移位距离、体表凹陷程度、乳房质地与弹性及皮肤色泽作为保留乳房治疗后的评判指标，于放射治疗后6个月综合评分判断美容效果。良好率差异比较采用卡方检验。结果共实施保留乳房手术162例，占同期乳腺癌手术患者的12．8％（162／1266），术后病理分期为0期32例，Ⅰ期83例，ⅡA期47例。全部病例获随访，复发率为9．9％（16／162）。保留乳房治疗后美容效果良好占61．1％（99／162），一般占35．2％（57／162），差占3．7％（6／162）。采用双切口、保留皮肤、肿瘤广泛切除及适形放射治疗等技术者美容效果良好率显著高于单切口、切除皮肤、象限切除及非适形放射治疗组（P〈0．01），而肿瘤分期和术后放射治疗开始时间是否早于12周对美容效果无影响（P〉0．05）。结论乳腺癌患者保留乳房治疗后美容效果良好，采用双切口、保留皮肤和肿瘤广泛切除等手术技巧以及适形放射治疗可提高保留乳房治疗的美容效果。

Analysis of the factors influencing cosmetic results after breast conserving therapy for breast cancer

Objective To retrospectively analyze relevant factors influencing cosmetic results after breast-conserving therapy in early-stage breast cancer patients. Method From November 1999 to December 2008, 162 patients with stage 0, I and II A breast cancer underwent breast-conserving surgery in our hospital. The distances of nipple lateral and vertical displacement, the degree of concave body surface, the breast texture and resilience, and the skin color were taken as postoperative evaluation index for breast conserving therapy. The cosmetic assessment was done six months ＇after radiotherapy. Fine and excellent rates were compared using ehi-square test. Results All the 162 patients were treated with breast conserving surgery, occupying 12.8% （162/1266） of the concurrent breast conserving surgeries. Postoperative pathological tumor staging showed stage 0 in 32 cases, stage I in 83 cases and stage IIA in 47 cases. All cases were followed up, demonstrating a relapse rate of 9.9% （16/162）. The cosmetic results showed that the good rate was 61.1% （99/162）, moderate rate 35.2% （57/162） and poor rate 3.7% （6/162）. The good rate of cosmetics in patients using two-incision, conserving skin, extent resection of tumors and conformal radiation therapy was significantly higher than in oneincision, skin excision, quadrantectomy and un-modulated radiation therapy（P〈0.01 ）. Tumor staging and whether the starting time for postoperative radiotherapy was earlier than 12 weeks did not affect the cosmetic results （ P〉0.05 ）. Conclusion Early breast cancer patients treated with breast-conserving surgery can obtain good cosmetic results. Two-incision, conserving skin, extent resection of tumors and conformal radiation therapy in breast-conserving treatment can improve cosmetic results.