球拍形切口乳房成形术在早期乳腺癌保乳手术中的应用

徐其; 郑丽; 徐丹英; 刘月; 沈靖

doi:10.16766/j.cnki.issn.1674-4152.002765

球拍形切口乳房成形术在早期乳腺癌保乳手术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002765

徐其¹,
郑丽^2, ,,
徐丹英¹,
刘月¹,
沈靖¹

1.
嘉兴市第二医院乳腺外科, 浙江嘉兴 314000
2.
嘉兴市第二医院中心实验室, 浙江嘉兴 314000

基金项目:

浙江省医药卫生科技计划项目 2018RC073

浙江省嘉兴市科技计划项目 2019AD32070

详细信息

通讯作者:
郑丽, E-mail: 794601639@qq.com

中图分类号: R737.9 R730.56
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出版历程
- 收稿日期: 2022-06-04
- 网络出版日期: 2023-02-07

Application of racquet-shaped incision mammoplasty in breast-conserving surgery for early-stage breast cancer patients

XU Qi¹,
ZHENG Li^{2
, ,},
XU Dan-ying¹,
LIU Yue¹,
SHEN Jing¹

1.
Department of Breast Surgery, the Second Hospital of Jiaxing, Jiaxing, Zhejiang 314000, China

摘要

摘要: 目的对比分析球拍形切口乳房成形术与传统保乳术在早期乳腺癌治疗中的临床效果。方法选取2019年1月—2020年12月在嘉兴市第二医院本部及南湖分院就诊的早期乳腺癌患者84例，使用随机数字表法将其分为实验组和对照组，各42例。实验组采用球拍形切口乳房成形术，对照组采用传统保乳术，比较2组患者术后美容效果、手术时间、术中出血量、切除标本体积、血清肿形成率、第1次切缘阳性率、术后切口感染率及全乳切除率。结果实验组术后美容效果优良率为90.5%，高于对照组的61.9%，差异有统计学意义(P＜0.01)。实验组切除标本体积为(89.4±23.1)mL，大于对照组的(67.7±23.9)mL，差异有统计学意义(P＜0.01)。实验组2例(4.8%)患者发生血清肿，少于对照组的19例(45.2%)，差异有统计学意义(P＜0.01)。实验组2例(4.8%)患者第1次切缘阳性，少于对照组的8例(19.0%)，差异有统计学意义(P＜0.05)。2组手术时间、术中出血量、切口感染率及全乳切除率差异无统计学意义(均P＞0.05)。中位随访时间为25个月，2组均未出现局部复发病例，实验组和对照组各有1例患者出现远处转移，2组远处转移率差异无统计学意义(P＞0.05)。结论在早期乳腺癌保乳手术中使用球拍形切口乳房成形术较传统保乳术可改善术后美容效果，减少血清肿发生，降低第1次切缘阳性率，值得推广应用。
- 早期乳腺癌 /
- 球拍形切口乳房成形术 /
- 传统保乳术
Abstract: Objective To compare the clinical efficacy of racquet-shaped incision mammoplasty and traditional breast-conserving surgery for early-stage breast cancer. Methods A total of 84 patients with early-stage breast cancer at the Second Hospital of Jiaxing and its Nanhu Branch from January 2019 to December 2020 were divided into experimental and control groups according to the random number table method, 42 cases in each group. The experimental group was treated with racquet-shaped incision mammoplasty, and the control group was treated with traditional breast-conserving surgery. The cosmetic effect, operation time, intraoperative blood loss, resected volume, rate of seroma, rate of positive margins in first resection, rate of infection and rate of mastectomy were compared between the two groups. Results An excellent to good rate of cosmetic effect was observed in the experimental group, with a value of 90.5%, which was higher than that of the control group (61.9%, P < 0.01). The resected volume in the experimental group was (89.4±23.1) mL, which was larger than that in the control group [(67.7±23.9) mL, P < 0.01]. The rate of seroma in the experimental group was 4.8%(2 cases), which was lower than that in the control group (45.2%, 19 cases, P < 0.01). The rate of positive margins in the first resection of the experimental group was 4.8% (2 cases), which was lower than that of the control group (19.0%, 8 cases, P < 0.05). No significant difference was observed in operative time, intraoperative blood loss, rate of infection and rate of mastectomy between the two groups (all P>0.05). The mean follow-up period was 25 months. All patients were free of local recurrence. There was 1 case of distant metastasis in each group, and there was no significant difference in the rate of distant metastasis between the two groups (P>0.05). Conclusion For early-stage breast cancer, racquet-shaped incision mammoplasty can improve breast aesthetics after operation and reduce the rates of seroma and positive margins in the first resection compared with traditional breast-conserving surgery. It is worth popularizing and applying.
- Early-stage breast cancer /
- Racquet-shaped incision mammoplasty /
- Traditional breast-conserving surgery

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图 1 球拍形切口乳房成形术简要手术步骤

注：A为术前标记；B为切除“球拍柄”；C为构建“球拍面”；D为手术完成。

Figure 1. Brief steps of racquet-shaped incision mammoplasty

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表 1 2组早期乳腺癌患者一般资料比较

Table 1. Comparison of patient characteristics between two groups of early-stage breast cancer patients

组别	例数	年龄 (x±s，岁)	肿瘤直径 (x±s，cm)	TNM分期[例(%)]		病理类型[例(%)]		腋窝淋巴结转移[例(%)]
组别	例数	年龄 (x±s，岁)	肿瘤直径 (x±s，cm)	Ⅰ	Ⅱ	浸润性癌	导管内癌	是	否
实验组	42	51.4±10.3	1.79±0.65	23(54.8)	19(45.2)	39(92.9)	3(7.1)	5(11.9)	37(88.1)
对照组	42	50.1±10.4	1.81±0.63	24(57.1)	18(42.9)	38(90.5)	4(9.5)	4(9.5)	38(90.5)
统计量		0.559^a	0.153^a	0.048^b		< 0.001^b		< 0.001^b
P值		0.578	0.879	0.826		0.999		0.999
注：^a为t值，^b为χ²值。

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表 2 2组早期乳腺癌患者美容效果比较

Table 2. Comparison of cosmetic effects between two groups of early-stage breast cancer patients

组别	例数	优 (例)	良 (例)	一般 (例)	差 (例)	优良率 (%)
实验组	42	21	17	2	2	90.5(38/42)
对照组	42	10	16	12	4	61.9(26/42)
注：2组优良率比较，χ²=9.450，P=0.002。

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表 3 2组早期乳腺癌患者术中及术后指标比较

Table 3. Comparison of intraoperative and postoperative parameters between two groups of early-stage breast cancer patients

组别	例数	手术时间 (x±s，min)	术中出血量 (x±s，mL)	切除标本体积 (x±s，mL)	血清肿 [例(%)]	切口感染 [例(%)]	第1次切缘阳性[例(%)]	全乳切除 [例(%)]
实验组	42	120.6±20.6	55.3±13.7	89.4±23.1	2(4.8)	1(2.4)	2(4.8)	1(2.4)
对照组	42	111.7±21.6	56.9±13.2	67.7±23.9	19(45.2)	2(4.8)	8(19.0)	2(4.8)
统计量		1.950^a	0.543^a	4.235^a	18.349^b	＜0.001^b	4.086^b	＜0.001^b
P值		0.055	0.589	＜0.001	＜0.001	0.999	0.043	0.999
注：^a为t值，^b为χ²值。

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