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目的 观察Ⅰ～Ⅱa期乳腺癌保留乳房手术加术后放疗及化疗的疗效。 方法 有选择地对 3 7例Ⅰ～Ⅱa期乳腺癌病人施行乳腺癌局部广泛切除加腋淋巴结清扫术。乳腺肿块位于 1区者原发癌灶与腋窝淋巴结清扫尽可能取与皮纹一致的梭形切口 ;位于 2、4区者原发癌灶取放射状切口 ;位于3区者取放射状切口或乳腺下方弧形切口。腋窝淋巴结清扫取腋窝皱襞下横形切口 ,前端至胸大肌外缘 ,后缘不超过腋后线。术中将距肿瘤 2cm边缘送快速病理检查 ,确保切缘无肿瘤残余。肿块切除后瘤床 4个方向各放一金属标志物 ,以指导放疗。切线照射乳腺及胸壁 ,依据金属标记瘤床加用电子线照射瘤床 ,共达 60～ 70Gy ,并辅以化疗、内分泌治疗。结果 平均随访 52 .8个月 ,均无局部复发 ,无远处转移 ,乳房无明显萎缩变形 ,保留乳房美容效果满意。 结论 该术式是治疗Ⅰ～Ⅱa期乳腺癌的首选方法之一 ,并可提高病人的术后生存质量
Objective To observe the curative effect of breast cancer surgery combined with postoperative radiotherapy and chemotherapy for stage I-IIa breast cancer. METHODS: Locally extensively resection of breast cancer plus axillary lymph node dissection was performed on 37 patients with stage I-IIa breast cancer. The breast tumor located in the first area of the primary cancer foci and axillary lymph node dissection as much as possible with the spindle-shaped incision; in the 2nd and 4th district of the primary tumor to take a radial incision; located in the 3rd area to take a radial incision or mammary gland Curved incisions. Axillary lymph node dissection was performed with a transverse incision under the folds of the axilla, with the front end to the outer edge of the pectoralis major muscle, and the posterior border not exceeding the posterior tibial line. During the operation, a rapid pathological examination was performed from the 2 cm edge of the tumor to ensure that there was no tumor residue at the margin. After the tumor was removed, a metal marker was placed in each direction of the tumor bed to guide radiotherapy. The breast and chest wall were irradiated by tangential irradiation, and the tumor bed was irradiated with electron beam irradiation on the tumor bed according to the metal mark. The total amount was 60 to 70 Gy, supplemented by chemotherapy and endocrine therapy. Results There was no local recurrence, no distant metastasis, no obvious atrophy of the breast, and satisfactory breast cosmetic results were retained after a mean follow-up of 52. 8 months. Conclusions This surgical procedure is one of the first choices for the treatment of stage I-IIa breast cancer, and it can improve the patient’s postoperative quality of life.