早期乳腺癌不同手术治疗疗效分析

目的比较早期乳腺癌保乳手术与改良根治术的疗效。方法分析108例早期乳腺癌的病历资料,其中改良根治术组56例,保乳组52例,比较两组病例的疗效及并发症。结果保乳组患者3年、5年局部控制率分别为98.1%和94.3%;远处转移率分别为1.6%和3.8%,生存率分别为100%和86.5%。改良根治术组患者3年、5年局部控制率分别为96.4%和95.3%,远处转移率分别为3.6%和4.7%,生存率分别为94.6%和69.6%比较,两组3年局部控制、5年局部控制、3年远处转移、5年远处转移以及3年生存率比较差异无统计学意义(P>0.05),保乳组患者的5年生存率显著高于改良根治组(P<0.05)。保乳组患者平均住院时间显著短于改良根治组(P<0.01),术后皮瓣坏死、皮下积液及上肢水肿及功能障碍等并发症发生率显著低于改良根治组(P<0.05),两组术后伤口感染率比较差异无统计学意义(P>0.05)。经手术治疗后,对保留乳房的满意调查结果显示,保乳组患者的满意率为100%;改良根治术组经治疗后,大部分患者感觉失去乳房,缺乏安全感及身体的平衡感,生活质量及情志有所降低。结论早期乳腺癌采用保乳手术综合疗法,可以达到与改良根治术相似的治疗效果,且提高了患者生存质量,可作为首选治疗方法。

Curative effect of different operations on early breast cancer

Objective To compare the therapeutic effect of modified radical mastectomy and breast conservative surgery on early breast cancer.Methods Medical records of 108 cases with early breast cancer were analyzed.Among them 56 cases were in the modified radical mastectomy operation group(the MRM group) and 52 cases in the breast conservative surgery group(the BCT group).The therapeutic effect and complications of these two groups were observed and compared.Results In the 3rd and fifth year,the local control rate of the BCT group were 98.1% and 94.3%,while the rate of distant metastases were 1.6% and 3.8% and the survival rates were 100% and 86.5%.For the MRM group,the above indexes were respectively 96.4%,95.3%,3.6%,4.7%,94.6% and 69.6%.Except for the survival rates of the fifth year,there were no significant differences when comparing these indexes between groups(P>0.05).In the fifth year after treatment,the BCT group had significantly higher survival rate than the MRM group(P<0.05).The BCT group had obviously shorter average hospitaliztion time than the MRM group(P<0.01).The BCT group also had much lower rates of complications such as skin flap necrosis,subcutaneous effusion,upper limb edema,dysfunction(P<0.05).No significant difference was found between the postoperative wound infection rates of the two groups(P>0.05).After the treatment,the satisfaction rate in the BCT group was 100% according to the breast satisfaction survey.But most patients of the MRM group felt losing their breast,had litttle sense of security and balance and declining life and emotional quality.Conclusion Breast conserving treatment could be regarded as the preferred therapy for early breast cancer because it not only has similar therapeutic efficacy as radical mastectomy but also can improve the quality of patients' life.