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目的 探讨中国女性乳腺癌保守手术的“安全边缘”及符合美学要求的保守治疗适应症。方法 以临床Ⅰ、Ⅱ期乳腺癌根治术标本作卫星灶空间分布分析 ,以期发现合理的安全边缘。对切除组织体积和乳房体积数据作比较分析 ,以确定适合中国女性乳腺癌保守治疗的适应症。结果 75 %的病例的卫星灶分布于距原发灶 2 .0cm的范围内。原发灶小于 2 .0cm者体积丢失均小于 2 0 %;当乳房体积分别大于 32 1ml和 339ml时 ,2 .1～ 2 .5cm及 2 .6～ 3 .0cm的肿瘤其体积丢失小于 2 0 %。结论 对中国女性早期乳腺癌患者而言 ,保守手术切缘应至少离肿瘤 2 .0cm ;从美学角度来看 ,不超过 2 .0cm的肿瘤为保守治疗最佳适应证 ,乳房大于 32 1ml和 339ml时 ,不超过 2 .5cm和 3 .0cm的肿瘤可作保守治疗。肿瘤大于 3 .0cm者 ,除非乳房体积较大 ,一般不宜作保守治疗。
Objective To explore the “safe margins” of conservative surgery for breast cancer in Chinese women and the indications for conservative treatment that meet the aesthetic requirements. Methods The spatial distribution of satellite lesions was analyzed with clinical specimens of stage I and stage II breast cancer radical mastectomy in order to find a reasonable margin of safety. A comparative analysis of resected tissue volume and breast volume data was conducted to determine the indications suitable for conservative treatment of Chinese women with breast cancer. Results In 75 % of the cases, the satellites were distributed within 2.0 cm from the primary tumor. The loss of volume of the primary tumor less than 2.0 cm was less than 20%; when the breast volume was greater than 32 1ml and 339ml respectively, the volume loss of tumors of 2.1-2.5cm and 2.6-3.0cm was less than 20%. %. Conclusion For Chinese women with early-stage breast cancer, conservative surgical margins should be at least 2.0 cm from the tumor; from an aesthetic point of view, tumors no larger than 2.0 cm are the best indication for conservative treatment, breasts larger than 32 1 ml and 339 ml At the time, tumors up to 2.5 cm and 3.0 cm can be treated conservatively. Tumors larger than 3.0 cm, unless the larger breast size, generally should not be conservative treatment.