摘要
目的探讨临床上不能触及乳房肿块，仅影像学检查表现为恶性钙化乳腺癌的病灶定位方法、手术方法及其治疗效果。方法对本院2003年11月-2007年8月间61例乳房体检不能触及肿块，仅X线钼靶片或B超显示恶性钙化病灶或局部血流丰富的乳腺癌（T1-2N0M0）患者进行术前全数字化平板乳腺机（fullfielddigitalmammography，FFDM）坐标法立体定位、术中精确定位切除、术毕FFDM标本复检，同时行广基带血管腺体组织瓣I期乳房内成形的保乳手术（单发病灶者）或乳腺癌改良根治术（多中心病灶者）。结果行保乳手术50例，坐标法定位准确率100％（50／50）；病灶切除完整，切缘均为阴性；FFDM复检无病灶残留；广基带血管腺体组织瓣乳腺I期成形结果，按波士顿哈佛放射治疗中心（JCRT）标准达优率86％（43／50），Compliance差值1．5cm。行乳腺癌改良根治术11例，均为乳腺外弥漫性恶性钙化多中心病灶。全组61例随访时间6～58个月（中位时间39个月），1例远处转移，无局部复发。结论行坐标法定位临床上不可触及肿块的乳腺癌准确有效、切实可行，对单发病灶者在FFDM定位下行保乳手术同时行广基带血管腺体组织瓣I期乳房内成形，创伤小、疗效满意，术后乳房美观度优良，尤其适用于中国人的情况。
Objective To study the methods of localization and effects of surgical treatment for palpation-negative breast cancer. Methods From November 2003 to August 2007, 61 patients with neither touchable mass nor mass image in radiography were diagnosed early breast cancer（ T1-2 N0M0 ） according to malignant calcification focus shown by radiography with full field digital mammography （FFDM） or rich local blood supply shown by ultrasonic examination in Jiangsu Province Tumor Hospital, first coordinate orientation was conducted, then accurate localization and excision were adopted and later FFDM sample re-examination was done. Patients with single lesion received breast-conserving surgery, which meaned the cancer lesion was excised precisely with the aid of preoperative localization by FFDM coordinate orientation, and breast reconstruction was accomplished synchronously by wide-based gland-tissue flap stage I breast reconstruction. The patients with multiple lesions received modified radical mastectomy. Results In the breast-conserving surgery given to the 50 patients, the accuracy of localization was 100% （50/50） ; breast single focus was excised completely with margin negative by FFDM and pathological examination; the superior rate of mammaplasty was 86% （43/50） according to JCRT. Compliance difference was 1.5cm. Modified radical mastectomy for breast cancer was given to the 11 patients with breast extramammary diffusive calcified focus： The follow-up period of 6 to 58 months in 61 patients （average time was 39 months）, distant metastases occurred in one and no local recurrence was observed. Conclusion Lesion localization in patients with breast single focus, breast-conserving surgery followed by synchronous wide-based gland-tissue flap stage I breast reconstruction is a new recommendable technique for breast minimally invasive surgery for its simple maneuver, minimal invasion and produces a fairly well-shaped. Such treatment is especially suitable for Chinese female patients with small breast.
出处
《肿瘤基础与临床》
2008年第6期495-499,共5页
journal of basic and clinical oncology
基金
江苏省科技发展项目重点科研课题(编号:BS2006006)
