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目的:探讨乳腺癌保乳手术的技巧和近期疗效。方法:临床Ⅰ～Ⅱ期女性乳腺癌300例行保乳手术,肿瘤直径<2 cm行区段切除,肿瘤直径≤3 cm行象限切除。标本切缘取标本作快速冰冻切片病理检查并行常规腋窝淋巴结清扫,切缘阴性时整形乳房,腺体拉拢间断缝合。术后残留乳房行全乳照射,剂量5 000 cGy,术后1周开始接受全身化疗。放疗后ER+者结合内分泌治疗5年,对300例患者进行复查随访。结果:300例手术全部成功,术后腋下积液30例,积液愈合后放疗。无残留乳腺术后并发症,因局部乳房缺损修复8例,余均整形乳房,腺体拉拢间断缝合。术后随访24～80个月,平均57月,随访率为85.0%(255/300)。局部复发率9.8%(25/255),行残乳切除术,现复查良好。对侧腋窝淋巴结转移发生率1.2%(3/255),时间平均为术后38个月。远处转移率2.0%(5/255),时间平均为术后48个月。死亡率2.0%(5/255),5年无病生存率85.1%(217/255),总生存率98.0%(250/255)。该组病例美容效果良好74.0%,一般17.0%,差9.0%。结论:保乳手术临床效果良好,应该大力推广。
Objective: To explore the breast-conserving surgery skills and short-term efficacy. Methods: Three hundred and seventy breast cancer patients with stage Ⅰ ~ Ⅱ breast - conserving surgery were resected. The tumor diameter was less than 2 cm. The resection was performed. The tumor size was ≤3 cm. Specimens specimens taken for rapid frozen section biopsy specimens routine axillary lymph node dissection, negative margins when shaping breast, gland contraction interrupted suture. Postoperative residual breast full-milk irradiation, a dose of 5 000 cGy, 1 week after surgery began to receive systemic chemotherapy. After radiotherapy ER + combined with endocrine therapy for 5 years, 300 patients were followed up. Results: All the 300 surgeries were successful. There were 30 cases of underarm effusion and radiotherapy after hemorrhage was healed. No residual breast surgery complications, due to local breast defect repair in 8 cases, more than average plastic breast, gland contraction interrupted suture. The patients were followed up for 24 to 80 months with an average of 57 months. The follow-up rate was 85.0% (255/300). Local recurrence rate of 9.8% (25/255), the line of residual excision surgery, is now a good review. The incidence of contralateral axillary lymph node metastasis was 1.2% (3/255), with an average of 38 months postoperatively. The distant metastasis rate was 2.0% (5/255), the average time was 48 months after surgery. The mortality rate was 2.0% (5/255). The 5-year disease-free survival rate was 85.1% (217/255) and the overall survival rate was 98.0% (250/255). The cosmetic effect of this group was good 74.0%, generally 17.0%, poor 9.0%. Conclusion: The effect of breast conserving surgery is good and should be vigorously promoted.