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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 228 -233. doi: 10.3877/cma.j.issn.1674-0807.2020.04.006

所属专题： 总编推荐； 文献；

论著

充气法单孔腔镜保留乳房手术在早期乳腺癌治疗中的应用
王子函1, 谢芳2, 闫笑生1, 张忠涛1, 武珊珊1, 伍海锐1, 屈翔1,†()   
  1. 1. 100050　首都医科大学附属北京友谊医院普通外科
    2. 100010　首都医科大学附属北京中医医院乳腺科
  • 收稿日期:2019-01-22 出版日期:2020-08-01
  • 通信作者: 屈翔

Single-port endoscopic breast-conserving surgery for early breast cancer

Zihan Wang1, Fang Xie2, Xiaosheng Yan1, Zhongtao Zhang1, Shanshan Wu1, Hairui Wu1, Xiang Qu1,†()   

  1. 1. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
    2. Department of Breast Diseases, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
  • Received:2019-01-22 Published:2020-08-01
  • Corresponding author: Xiang Qu
  • About author:
    Corresponding author: Qu Xiang, Email: .
    Wang Zihan and Xie Fang contributed equally to this paper.
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引用本文：

王子函, 谢芳, 闫笑生, 张忠涛, 武珊珊, 伍海锐, 屈翔. 充气法单孔腔镜保留乳房手术在早期乳腺癌治疗中的应用[J]. 中华乳腺病杂志(电子版), 2020, 14(04): 228-233.

Zihan Wang, Fang Xie, Xiaosheng Yan, Zhongtao Zhang, Shanshan Wu, Hairui Wu, Xiang Qu. Single-port endoscopic breast-conserving surgery for early breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(04): 228-233.

目的

探讨充气法单孔腔镜保留乳房(简称保乳)手术在早期乳腺癌治疗中的应用。

方法

回顾性分析2017年5月至2018年11月在首都医科大学附属北京友谊医院诊断为Ⅰ、Ⅱ期乳腺癌且行保乳手术的102例患者临床资料，其中行单孔法腔镜保乳手术者48例(腔镜组)，行开放保乳手术者54例(开放组)，对患者的手术时间、美容效果、并发症及复发情况进行评估。2组患者间手术时间、美容效果的比较采用两独立样本的t检验。

结果

102例患者均成功完成相应单孔法腔镜保乳或开放保乳手术，其中腔镜组手术时间为(184.2±76.2) min，开放组手术时间为(127.8±68.4) min，2组相比，差异有统计学意义(t＝3.923, P<0.001)。术后2个月进行美容效果评估：腔镜组美容效果评分明显高于开放组[(11.2±0.8)分比(9.1±0.9)分，t＝6.407, P<0.001]。2组患者术后均无皮肤坏死、活动性出血、感染等并发症。中位随访时间11.2个月，2组患者均无局部复发或远处转移病例。

结论

充气法单孔腔镜保乳手术在保证早期乳腺癌肿瘤根治性的同时，可以较开放保乳手术获得更好的美容效果。

关键词: 乳腺肿瘤, 内窥镜检查, 乳房切除术
Objective

To explore the application of the single-port endoscopic breast-conserving surgery in the treatment of early breast cancer.

Methods

The clinical data of 102 patients with stage I and II breast cancer who underwent breast-conserving surgery in the Beijing Friendship Hospital, Capital Medical University from May 2017 to November 2018 were retrospectively analyzed. Among them, 48 patients underwent single-port endoscopic breast-conserving surgery (endoscopic surgery group) and 54 patients received open breast-conserving surgery (open surgery group). The operative time, cosmetic effect, complications and recurrence were assessed. The t test of two independent samples was used to compare the operation time and cosmetic effect between the two groups.

Results

All 102 patients had successfully completed the surgery. The operative time in the endoscopic surgery group was (184.2 ±76.2) min, significantly longer than (127.8 ±68.4) min in the open surgery group (t=3.923, P<0.001). The cosmetic evaluation at postoperative two months showed that the score of cosmetic effect in the endoscopic surgery group was significantly higher than that in the open surgery group (11.2±0.8 vs 9.1±0.9, t=6.407, P<0.001). There was no skin necrosis, active bleeding and infection in both groups. The median follow-up was 11.2 months. There was no local recurrence or distant metastasis in both groups.

Conclusion

The single-port endoscopic breast-conserving surgery can guarantee the radical resection of early breast cancer, and obtain better cosmetic effect compared with open breast-conserving surgery.

Key words: Breast neoplasms, Endoscopy, Mastectomy
图1 充气法单孔腔镜保留乳房手术前置入切口撑开圈套将切口撑开　a图所示，将切口撑开圈套一端置入手术切口；b图所示，切口撑开圈套外露端折叠后可以与充气套筒连接
图2 充气法单孔腔镜保留乳房手术中放置单孔套筒及充气装置
图3 充气法单孔腔镜保留乳房手术中取出标本
表1 腔镜组与开放组乳腺癌患者基线资料比较
组别 例数 年龄(岁) 肿瘤最大径(cm) 病变部位[例(%)] TNM分期[例(%)] 相关受体[例(%)]
左乳 右乳 Ⅰ期 Ⅱ期 ER(＋) PR(＋) HER-2(＋)
腔镜组 48 53.1±8.8 1.7±0.6 25(52.1) 23(47.9) 28(58.3) 20(42.7) 35(72.9) 33(68.8) 19(39.6)
开放组 54 54.5±10.5 2.0±0.7 29(53.7) 25(46.3) 38(70.3) 16(29.7) 37(68.5) 30(55.6) 22(40.8)
检验值   t＝-0.715 t＝-1.822 χ2＝0.027 χ2＝1.612 χ2＝0.237 χ2＝1.873 χ2＝0.014
P值   0.476 0.071 0.870 0.204 0.627 0.171 0.905
表2 腔镜组与开放组乳腺癌患者术中、术后相关数据比较
组别 例数 手术时间(min) 切口长度(cm) 术中出血量[ml，M(P25～P75)] 总引流量[ml，M(P25～P75)] 引流管留置[d，M(P25～P75)] 住院时间(d) 美容效果(分)
腔镜组 48 184.2±76.2 3.3±1.1 20(10.0～40.0) 102.5(60.0～171.5) 5(3，6) 11.1±3.8 11.2±0.8
开放组 54 127.8±68.4 5.8±2.6 20(10.0～22.5) 65.2(37.0～44.5) 5(4，6) 10.1±3.1 9.1±0.9
检验值   t＝3.923 t＝-6.321 Z＝-0.465 Z＝-2.091 Z＝1.139 t＝1.480 t＝6.407
P值   <0.001 <0.001 0.624 0.073 0.255 0.142 <0.001
图4 乳腺癌患者行充气法单孔腔镜保留乳房手术后美容效果
[1]
Botteri E, Veronesi P, Vila J, et al. Improved prognosis of young patients with breast cancer undergoing breast-conserving surgery[J]. Br J Surg, 2017，104(13): 1802-1810.
[2]
Van Maaren MC, De Munck L, De Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study[J]. Lancet Oncol, 2016, 17(8): 1158-1170.
[3]
Zhao S, Liu Y, Huang F, et al. The long-term outcome of adjuvant hypofractionated radiotherapy and conventional fractionated radiotherapy after breast-conserving surgery for early breast cancer：a prospective analysis of 107 cases[J]．J Thorac Dis, 2017, 9(10): 3840-3850.
[4]
王子函，王岳月，滕长胜，等．单孔悬吊法腔镜保乳手术与开放保乳手术在早期乳腺癌治疗中的对照研究[J]．临床和实验医学杂志，2016，15(13): 1306-1310.
[5]
张慧明，伍海锐，王子函，等. 腔镜保乳手术联合射频消融术治疗早期乳腺癌的临床研究[J]．国际外科学杂志，2017，44(6): 392-396.
[6]
de Kock I, Mirhosseini M, Lau F, et al. Conversion of Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG) to Palliative Performance Scale (PPS), and the interchangeability of PPS and KPS in prognostic tools[J]. J Palliat Care, 2013，29(3): 163-169.
[7]
Yamashita K. Cosmetic assessment[J]. J Jpn Soc Endosc Surg, 2005，10(2): 165-170.
[8]
孙可欣，郑荣寿，顾秀瑛，等.2000—2014年中国肿瘤登记地区女性乳腺癌发病趋势及年龄变化情况分析[J]．中华预防医学杂志，2018, 52(6): 567-572.
[9]
Aerts L, Christiaens MR, Enzlin P, et al. Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: a prospective controlled study[J]. Breast, 2014，23(5): 629-636.
[10]
Christiansen P, Carstensen SL, Ejlertsen B, et al.Breast conserving surgery versus mastectomy：overall and relative survival-a population based study by the Danish Breast Cancer Cooperative Group (DBCG) [J]．Acta Oncol, 2018, 57 (1): 19-25.
[11]
刘婷，韩宝三．乳腺癌保乳整复手术：根治与保乳的平衡[J]．上海医药，2018，39(19): 15-19.
[12]
黄欣，陈畅，周易冬，等．乳腺导管原位癌保留乳房手术后序贯放射治疗的研究进展[J/CD]．中华乳腺病杂志(电子版)，2018，12(1): 50-54.
[13]
Vila J, Gandini S, Gentilini O. Overall survival according to type of surgery in young (≤40 years) early breast cancer patients: A systematic meta-analysis comparing breast-conserving surgery versus mastectomy[J]. Breast, 2015，24(3): 175-181.
[14]
Milone M, Elmore U, Musella M, et al. Safety and efficacy of laparoscopic wedge gastrectomy for large gastrointestinal stromal tumors[J]．Eur J Surg Oncol, 2017, 43 (4): 796-800.
[15]
Ha TY, Yoon YI, Hwang S，et al. Effect of reoperation on long term outcome of pT1b/T2 gallbladder carcinoma after initial laparoscopic cholecystectomy[J]．J Gastrointest Surgy，2015，19(2): 298-305.
[16]
王子函，张玉龙，王捷，等．保留乳头乳晕的单孔法腔镜皮下乳腺切除术治疗早期乳腺癌的临床疗效[J]．腹腔镜外科杂志，2018，23(3): 188-193.
[17]
胡俊丰，李明，胡超，等．乳腔镜乳房皮下腺体切除术治疗男子乳腺发育17例[J]．中国微创外科杂志，2019，19(1): 15-18.
[18]
姜军. 乳腺疾病腔镜治疗[M]．北京：人民卫生出版社，2012：4-12.
[19]
Wang ZH, Qu X, Teng CS, et al. Preliminary results for treatment of early stage breast cancer with endoscopic subcutaneous mastectomy combined with endoscopic sentinel lymph node biopsy in China[J]. J Surg Oncol，2016, 113(6): 616-620.
[20]
骆成玉. 微创与功能——乳腺外科"加减法" [J/CD]．中华腔镜外科杂志(电子版)，2018，11(4): 199-202.
[21]
刘嘉琦，何贵金．乳腔镜下腋窝淋巴结清扫术与常规腋窝淋巴结清扫术术后恢复及并发症的临床比较[J/CD]．中华乳腺病杂志(电子版)，2017，11(4): 218-222.
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