探讨保留乳房手术联合腔镜腋窝淋巴结清扫术(简称腔镜保乳术)治疗早期乳腺癌的疗效。

纳入2009年7月至2011年7月在新疆克拉玛依市中心医院普通外科就诊的60例早期乳腺癌患者进行前瞻性分析。根据患者意愿分配入腔镜保乳术组(16例)，传统保留乳房手术组(20例)，改良根治术组(24例)。采用χ²检验和Fisher确切概率法比较术后1年、3年、5年时3组患者在患肢活动功能障碍、患肢淋巴水肿、切口瘢痕、患肢疼痛、患肢感觉异常、局部复发、远处转移、病死率及乳房美容效果等方面的差异。

腔镜保乳术组5年局部复发率和病死率均为1/16，传统保留乳房手术组(简称保乳术组)5年局部复发率和病死率均为5.0%(1/20)，改良根治术组5年局部复发率和病死率均为4.2%(1/24)，3组的5年局部复发率及病死率差异无统计学意义(P＝1.000)。术后1年3组患者切口瘢痕形成率分别为0、60.0%(12/20)、100%(24/24)( χ²＝40.000，P<0.001)，患肢感觉异常发生率分别为1/16、30.0%(6/20)、50.0%(12/24) (χ²＝8.530，P＝0.014)，组间差异均有统计学意义。术后3年时3组患者患肢活动功能障碍的发生率分别为0、0、29.2%(7/24)(P＝0.002)，切口瘢痕的发生率分别为0、50.0%(10/20)、91.7%(22/24)(χ²＝32.545，P<0.001)，患肢感觉异常的发生率分别为0、10.0%(2/20)、33.3%(8/24) (P＝0.011)，差异均有统计学意义。术后5年时3组患者患肢活动功能障碍发生率分别为0、0、25.0%(6/24) (P＝0.007)，切口瘢痕的发生率分别为0、45.0%(9/20)、83.3%(20/24)(χ²＝27.609，P<0.001)，患肢感觉异常的发生率分别为0、10.0%(2/20)、33.3%(8/24) (P＝0.011)，差异均有统计学意义。在术后1年、3年和5年时，腔镜保乳术组的切口瘢痕形成少于保乳术组(P<0.001、0.001、0.002)和改良根治术组(P均<0.001)，其余并发症发生率与保乳术组差异无统计学意义，但是在患肢感觉异常方面明显优于改良根治术组(P＝0.005、0.013、0.013)。3组患者在术后1年、3年和5年的并发症发生率差异均有统计学意义(χ²＝32.237、31.917、16.481，P均<0.001)，腔镜保乳术组在术后1年和3年时明显少于保乳术组(Bonferroni校正P＝0.001、0.009)。术后5年腔镜保乳术组与保乳术组在乳房美容效果方面差异无统计学意义(P ＝0.715)。

保留乳房手术联合腔镜腋窝淋巴结清扫术不增加乳腺癌患者的复发、转移率，同时具有手术创伤小、并发症少和瘢痕不明显等优势。

To explore efficacy of breast-conserving surgery (BCS) combined with endoscopic axillary lymph node dissection (EALND) in the treatment of early breast cancer.

A total of 60 patients with early breast cancer in the Department of General Surgery, Karamay Central Hospital from July 2009 to July 2011 were enrolled for a prospective study. The patients were divided into three groups according to their wishes: BCS+ EALND group (16 cases), BCS group (20 cases) and modified radical mastectomy (MRM) group (24 cases). χ² test and the Fisher exact test was used to compare the dysfunction, lymphedema, pain and paresthesia of limbs, incision scar, local recurrence, distant metastasis, mortality and cosmetic effect across three groups at 1, 3 and 5 years after surgery.

The local recurrence rate and mortality were 1/16 and 1/16 in BCS+ EALND group, 5.0%(1/20) and 5.0%(1/20)in BCS group, 4.2%(1/24) and 4.2%(1/24) in MRM group. No significant difference was found in the local recurrence rate and mortality across three groups (P=1.000). At one year after surgery, the incidence of incision scar in three groups was 0, 60.0%(12/20) and 100%(24/24)( χ²=40.000, P<0.001), and incidence of limb paresthesia was 1/16, 30.0%(6/20) and 50.0%(12/24)(χ²=8.530, P=0.014), and the difference was statistically significant across three groups. At 3 years after surgery, the incidence of movement dysfunction was 0, 0, 29.2%(7/24)(P=0.002), the incidence of incision scar was 0, 50.0%(10/20), 91.7%(22/24)(χ²=32.545, P<0.001), the incidence of limb paresthesia was 0, 10.0%(2/20), 33.3%(8/24) (P=0.011), and the difference was statistically significant across three groups. At 5 years after surgery, the incidence of movement dysfunction was 0, 0, 25.0%(6/24) (P=0.007), the incidence of incision scar was 0, 45.0%(9/20), 83.3%(20/24)( χ²=27.609, P<0.001), the incidence of limb paresthesia was 0, 10.0%(2/20), 33.3%(8/24) (P=0.011), and the difference was statistically significant across three groups. At 1, 3 and 5 years after surgery, the occurrence of incision scar in BCS+ EALND group was significantly lower than that in BCS group (P<0.001, 0.001, 0.002) or MRM group (both P<0.001); the incidence of other complications in BCS+ EALND group was similar to that in BCS group while the occurrence of limb paresthesia in BCS+ EALND group was significantly lower than that in MRM group (P=0.005, 0.013, 0.013). There was significant difference in the complication rate across three groups at 1, 3 and 5 years after surgery (χ²=32.237, 31.917, 16.481, all P<0.001); the complication rate in BCS+ EALND group was significantly lower than that in BCS group at 1 and 3 years after surgery (Bonferroni correction: P=0.001, 0.009). There was no significant difference in cosmetic effect between BCS+ ELAND group and BCS group (P =0.715).

BCA combined with EALND has the advantages of less surgical trauma, fewer complications and less visible incision scar, without increasing the rate of recurrence and metastasis.