乳癌保乳手术适应证的探讨

目的：探讨乳腺癌保乳手术的合理适应证。方法：回顾性分析104例乳腺癌保乳手术患者的年龄、肿瘤大小、肿瘤部位、腋淋巴结状态、临床分期、病理类型等因素在保乳手术决策中的价值。结果：本组患者100例得到随访，失访4例，随访率96．4％；随访时间1～56个月，中位随访时间42个月。其中1例于手术后26个月发现原发性子宫内膜癌，49个月后死亡；1例12个月后同侧腋窝复发改行改良根治术；1例发现同侧锁骨上淋巴结转移行放疗；1例发现对侧原发性乳房癌行根治性手术(原保乳侧为导管浸润癌，对侧再发为导管内癌)；1例患乳再发纤维腺瘤而做局部切除术。结论：保乳手术将逐渐成为I、II期乳腺癌患者的主流手术，甚至部分IIIA期患者在新辅助化疗后可以获得保乳机会，保乳手术的适应证有扩大的趋势。

Clinical Exploration of the Indication of Breast-conserving Therapy in Breast Cancer Operation

Objective: To explore the reasonable indication of breast-conserving therapy in breast cancer operation . Methods: Review analysis the value of the factors such as the age of patient ,the tumor size ,the region of the tumor ,the condition of axillary lymph node ,the clinical stage and the pathology type in the decision-making of the patients. Results: We got postoperative visiting in 100patients and 4 patients lost. The postoperative visiting rate is 96.4%;The visiting time from 1 month to 56 months. There is one patient suffered from primary uterine endometrium cancer in 26 months, who died 23 months later. And one patient got the same lateral radical mastectomy one year later because of axillary recurrence; One got radiotherapy because of the same later upperior clavical lymph node metastasis; one got radical mastectomy in contralateral breast because of primary breast cancer (pathology :the primary breast is infiltrating ductual carcinoma, and the contralateral breast is intracluctal carcinoma )Another patient got secondly local resection because of fibroadenoma appeared in the same breast. Conclusion: The breast-conserving therapy become the main procedure in stage I and II breast carcinoma patients, and some stage IIIa patients will get the chance to preserve their breast after newadjuvant chemotherapy. The indication of breast preservation operation is extending.