射频消融联合腔镜微创保乳治疗早期乳腺癌的医学美学评价

目的评价射频消融（radiofrequency ablation，RFA）联合腔镜微创保乳治疗早期乳腺癌的医学美学效果。方法选择早期乳腺癌（T1-2N0-1M0）单侧单发病例，在术前常规化疗的同时，对乳腺肿瘤局部行B超引导下RFA治疗，然后行病变乳腺叶段切除和腔镜下前哨淋巴结染色活检与选择性腋窝淋巴结微创清扫术。术后随访3年以上，通过问卷法自我评价医学美学效果，并与传统保乳手术进行比较。结果直径≤3cm[平均（2．10±0．83）cm，最小1．20cm，最大3．00cm]的早期乳腺癌单侧单发共23例，肿瘤完全消融率95．6％（22／23），成功完成微创保乳术22例。RFA联合腔镜微创保乳治疗不仅瘢痕微小，而且乳房外形和腋窝形态明显优于传统手术，患者自我评分满意率100％，医学美学评分优良率95．5％（21／22）。结论RFA联合腔镜微创保乳治疗早期乳腺癌可获得更好的医学美学效果。

Cosmetic assessment of radiofrequency ablation combined with endoscopic breast conservation surgerv for treatment of early breast cancer

Objective Radiofrequency ablation (RFA) and endoscopic breast conserving surgery (EBCS) has been developed as a potential means for treating breast tumors with minimal disruption to adjacent soft tissues.The purpose of this study was to evaluate the cosmetic outcomes of RFA assisted by EBCS on patients with early breast carcinoma (T1 -2 N0-1 M0).Methods Twenty-three patients with biopsy proven invasive breast carcinoma ( ≤3 cm in diameter),were treated with ultrasound (US)guided percutaneous-RFA for the local tumors followed by sentinel lymph node biopsy and endoscopic auxiliary node dissection and lumpectomy.The reactions to breast cosmetics were observed and compared to the conventional approaches using the breast asymmetry score for EBCS and a self -assessment questionnaire targeting objective and subjective data about treatment related breast change.Results Twenty-three patients were successfully treated with RFA.Complete coagulation necrosis of the tumor was visualized at US and mammography in 22 of 23 patients (95.6 ％).22 patients being per formed RFA and EBCS presented little scars and the breasts preserved more cosmetically acceptable than the reported results of traditional protocols.Self-assessment acceptable rate was 100 ％,aesthetic outcome as good or excellent rated in 95.5 ％(21/22).Within the follow-up of above 36 months,there were no local recurrence,metastasis,wound infection or necrosis,nerve damage,haematoma,as well as upper limb swelling or lymphoedema,no reduced upper limb mobility and tumor seeding.Conclusions RFA with endoscopic breast conservation therapy for the treatment of early breast carcinoma is more effective and cosmetically acceptable than the traditional approaches.