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目的探讨临床Ⅰ、Ⅱ期乳腺癌选择性行乳腺癌保留乳房治疗(BCT)的远期生存、同侧乳腺复发(IBR)、美容效果及其相关因素。方法对1985年10月至2000年12月收治的270例Ⅰ、Ⅱ期乳腺癌患者进行BCT远期疗效的临床研究。乳腺癌保乳手术先后采用乳腺象限/区段切除术及肿瘤扩大切除术,联合全腋窝淋巴结清扫术。术后放射治疗先后采用60Co及加速器全乳放射治疗及瘤床缩野照射。结果在10年的中位随访时间内,270例BCT患者10年总生存率83.7%、IBR8.5%、远处转移率23.7%。患者年龄、肿瘤大小、病理组织学类型、腋窝淋巴结转移状况等临床病理因素对BCT后IBR无显著性影响(均P>0.05),切缘阳性、术后未行全乳照射的患者IBR显著升高(均P=0.000)。在确保切缘阴性的前提下,不同切除范围的手术方式对IBR无显著性影响(P=0.799),但切除范围较大的区段/象限切除术对BCT后乳房美容效果有显著不良影响(优秀P=0.043,优秀+良好P=0.005)。结论①临床Ⅰ、Ⅱ期乳腺癌选择性行BCT有较高的远期疗效、较好的美容效果和较低的IBR,可以安全地替代乳房切除性手术。②确保切缘阴性及接受术后全乳放射治疗仍是现阶段乳腺癌BCT的金标准。③在确保切缘阴性的前提下,切除范围较小的肿瘤扩大切除术有较好的美容效果和相同的治疗效果。
Objective To investigate the long-term survival, ipsilateral breast recurrence (IBR), cosmetic effects and related factors in breast cancer patients with stage Ⅰ and Ⅱ breast cancer. Methods A total of 270 patients with stage I and II breast cancer admitted to our hospital from October 1985 to December 2000 were enrolled in this study. Breast breast conserving surgery has adopted the breast quadrant / segmentectomy and tumor resection, combined with axillary lymph node dissection. Postoperative radiotherapy has used 60Co and accelerator whole milk radiotherapy and tumor shrinking field irradiation. Results The 10-year overall survival was 83.7%, IBR 8.5%, and distant metastasis rate in 270 BCT patients at a median follow-up of 10 years. The age, tumor size, pathological type, axillary lymph node metastasis and other clinical and pathological factors had no significant effect on post-BCT IBR (all P> 0.05). The positive margins and postoperative IBR were significantly increased High (all P = 0.000). While margins were negative, there was no significant difference in IBR between surgical resections with different resection ranges (P = 0.799). However, resection with segmentectomy / quadrant resection with a large excision range had a significant adverse effect on breast cosmetic outcome after BCT (P = Excellent P = 0.043, excellent + good P = 0.005). Conclusion ① BCT in patients with stage Ⅰ and Ⅱ breast cancer have higher long-term curative effect. Better cosmetic results and lower IBR can safely replace mastectomy. ② to ensure that the negative margin and accept postoperative whole milk radiotherapy is still the gold standard for breast cancer BCT at this stage. ③ In ensuring the negative margin of the premise, the resection of a smaller tumor resection has a better cosmetic effect and the same treatment.