保留乳头乳晕的皮下腺体切除在乳腺癌外科治疗中的应用体会

发布时间：2018-03-08 12:14

本文选题：乳腺癌　切入点：外科治疗　出处：《广西医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：探讨保留乳头乳晕的皮下腺体切除在乳腺癌外科治疗中应用的可行性及临床意义。方法：收集广西医科大学附属肿瘤医院2008年01月至2015年12月患者不同意或不适合保乳的201例乳腺癌患者的临床资料,其中行保留乳头乳晕皮下腺体切除(NSM)+前哨淋巴结活检(SLNB)/腋窝淋巴结清扫术(ALND)±乳房重建的乳腺癌患者88例为研究组,对照组为同期接受全乳房切除+SLNB/ALND±乳房重建的乳腺癌患者113例。对比两组患者的局部复发率、远处转移率、无瘤生存率和总生存率,观察乳头乳晕坏死情况及对再造乳房进行评价。结果：研究组和对照组中位随访时间分别为48个月和51个月,研究组患侧乳头乳晕复合体复发2例,对照组患侧胸壁皮肤复发2例,研究组和对照组的局部复发率分别为2.3%和1.8%,差异无统计学意义(P=1.000),远处转移率分别为6.8%和6.2%,差异无统计学意义(P=0.858)；五年无瘤生存率分别为87.8%和92.5%,差异无统计学意义(P=0.406)；五年生存率分别为96.9%和99.0%,两者比较无统计学差异(P=-0.366)。无乳头乳晕坏死,NSM联合乳房重建术后美学满意度Harris评价优良率为100%。结论：在乳腺癌外科手术治疗中,严格选择患者进行NSM,安全、可行,与全乳房切除术相比,未增加局部复发率,并且结合乳房重建能够取得令人满意的美观效果,NSM值得推广应用。
[Abstract]:Objective: to investigate the feasibility and clinical significance of subcutaneous gland resection with nipple-sparing areola in the surgical treatment of breast cancer. Methods: the patients of Cancer Hospital affiliated to Guangxi Medical University from January 2008 to December 2015 were collected. Or clinical data of 201 breast cancer patients who are not suitable for breast-conserving, The study group consisted of 88 patients with breast cancer undergoing subcutaneous gland resection of nipple and areola and Sentinel lymph node biopsy (SLNBN) / axillary lymph node dissection (ALND) 卤breast reconstruction. The control group was treated with total mastectomy SLNB/ALND + breast reconstruction. The local recurrence rate, distant metastasis rate, tumor-free survival rate and overall survival rate were compared between the two groups. Results: the median follow-up time of the study group and the control group was 48 months and 51 months respectively. In the control group, there were 2 cases of skin recurrence in the chest wall. The local recurrence rates of the study group and the control group were 2.3% and 1.8, respectively. There was no significant difference in the local recurrence rate between the two groups. The distant metastasis rates were 6.8% and 6.2, respectively. There was no significant difference between the two groups, and the 5-year tumor-free survival rate was 87.8% and 92.5, respectively. There was no significant difference between the two groups. The 5-year survival rate was 96.9% and 99.0, respectively. There was no significant difference between the two groups. The Harris evaluation of aesthetic satisfaction with nipple areola necrosis and breast reconstruction was 100%. Conclusion: in the surgical treatment of breast cancer, the excellent and good rate is 100%. It is safe and feasible to select NSM.Compared with total mastectomy, the local recurrence rate is not increased, and the combination of breast reconstruction can achieve a satisfactory aesthetic effect. NSM is worth popularizing.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.9

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