目的

探讨临床Ⅰ、Ⅱ期乳腺癌选择性行乳腺癌保留乳房治疗（BCT）的远期生存、同侧乳腺复发（IBR）、美容效果及其相关因素。

方法

对1985年10月至2000年12月收治的270例Ⅰ、Ⅱ期乳腺癌患者进行BCT远期疗效的临床研究。乳腺癌保乳手术先后采用乳腺象限/区段切除术及肿瘤扩大切除术，联合全腋窝淋巴结清扫术。术后放射治疗先后采用⁶⁰Co及加速器全乳放射治疗及瘤床缩野照射。

结果

在10年的中位随访时间内，270例BCT患者10年总生存率83.7%、IBR 8.5%、远处转移率23.7%。患者年龄、肿瘤大小、病理组织学类型、腋窝淋巴结转移状况等临床病理因素对BCT后IBR无显著性影响（均P﹥0.05），切缘阳性、术后未行全乳照射的患者IBR显著升高（均P=0.000）。在确保切缘阴性的前提下，不同切除范围的手术方式对IBR无显著性影响（P=0.799），但切除范围较大的区段/象限切除术对BCT后乳房美容效果有显著不良影响（优秀P=0.043，优秀+良好P=0.005）。

结论

①临床Ⅰ、Ⅱ期乳腺癌选择性行BCT有较高的远期疗效、较好的美容效果和较低的IBR，可以安全地替代乳房切除性手术。②确保切缘阴性及接受术后全乳放射治疗仍是现阶段乳腺癌BCT的金标准。③在确保切缘阴性的前提下，切除范围较小的肿瘤扩大切除术有较好的美容效果和相同的治疗效果。

Objective

To evaluate the long-term survival，ipsilateral breast recurrence（IBR）and cosmetic results of breast conservative therapy（BCT）for stage Ⅰ and Ⅱ breast cancer.

Method

From Oct.1985 to Dec.2000，BCT were performed in 270 patients with stage Ⅰ and Ⅱ breast cancer.Breast conserving surgery included quadrantectomy，sector resection，and lumpectomy，combined with whole axillary lymph node dissection.⁶⁰Co and accelerator were used for whole breast and booster irradiations.

Results

Median follow up of 10 years showed the 10-year overall survival，IBR，and distant metastasis rates were 83.7%，8.5%，and 23.7%，respectively in the 270 patients.While patient age，tumor size，histopathological type，and axillary node status had no relationship with IBR（P﹥0.05 for all），IBR was significantly high in patients with positive margin and without postoperative whole breast radiation（P=0.000）.Under the circumstance of assured clear margins，there was no difference of IBR between quadrantectomy/sector resection and lumpectomy（P=0.799），but the former had poor cosmetic results（P﹤0.05）.

Conclusions

①BCT has the effect of high rate of long-term survival，low rate of IBR and good cosmetic results，and can safely replace mastectomy for patients with stage Ⅰ and Ⅱ breast cancer；②Clear margin and whole breast irradiation are still gold standard for BCT at the moment；③Lumpectomy has better cosmetic results and same curative effect compared to quadrantectomy/sector resection.