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中华乳腺病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 71 -76. doi: 10.3877/cma.j.issn.1674-0807.2021.02.002

所属专题: 文献

论著

乳腺导管内乳头状瘤手术方式的比较及复发因素分析
杨璟1, 王森茂1, 李斌1,()   
  1. 1. 030001 山西省太原市中心医院乳腺外科
  • 收稿日期:2019-04-15 出版日期:2021-04-01
  • 通信作者: 李斌

Surgical methods and risk factors of recurrence for breast intraductal papilloma

Jing Yang1, Senmao Wang1, Bin Li1,()   

  1. 1. Department of Breast Surgery, Taiyuan Central Hospital, Taiyuan 030001, China
  • Received:2019-04-15 Published:2021-04-01
  • Corresponding author: Bin Li
引用本文:

杨璟, 王森茂, 李斌. 乳腺导管内乳头状瘤手术方式的比较及复发因素分析[J/OL]. 中华乳腺病杂志(电子版), 2021, 15(02): 71-76.

Jing Yang, Senmao Wang, Bin Li. Surgical methods and risk factors of recurrence for breast intraductal papilloma[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2021, 15(02): 71-76.

目的

探讨肿块切除、区段切除和腺叶切除3种手术方式对乳腺导管内乳头状瘤的治疗效果及术后复发因素。

方法

回顾性分析2010年1月至2014年12月太原市中心医院收治的279例乳腺导管内乳头状瘤患者临床资料,比较不同手术方式的术中及术后情况,分析术后复发的影响因素。计量资料(手术时间、术中出血量、住院时间、手术费用)的比较采用单因素方差分析;计数资料(乳头区感觉异常等)的比较采用χ2检验,等级资料(外观满意度)比较采用Kruskal-Wallis H检验;多因素分析采用logistic回归分析。

结果

3种手术方式比较,手术费用的差异有统计学意义[肿块切除术组(n=108):(840.9±361.7)元,区段切除术组(n=96):(1 840.8±473.6)元,腺叶切除术组(n=75):(1 761.2±370.5)元,F=969.65,P<0.001],而手术时间、术中出血量及住院时间的差异均无统计学意义(F=2.88、2.40、2.54,P=0.058、0.092、0.081),乳头区感觉异常及外观满意度的差异也均无统计学意义(χ2=1.77、1.83,P=0.430、0.400)。单因素分析发现,年龄、合并非典型增生、肿瘤直径、手术方式和肿瘤类型对术后复发均有影响(χ2=3.98、6.68、8.56、21.34、20.24,P=0.046、0.010、0.003、<0.001、<0.001);将其进行logistic回归分析发现,影响术后复发的危险因素包括年龄≥45岁、合并非典型增生、肿瘤直径≥1 cm、周围型乳头状瘤(OR=2.27,95%CI:1.00~5.12,P=0.048;OR=4.73,95%CI:2.07~10.78,P<0.001;OR=2.17,95%CI:1.03~4.56,P=0.040;OR=3.13,95%CI:1.25~7.82,P=0.015)和手术方式(以腺叶切除术为参照,肿块切除术是腺叶切除术复发风险的2.65倍,区段切除术是腺叶切除术的2.17倍)。按肿瘤类型进行分层分析发现,对于中央型乳头状瘤患者,年龄≥45岁、合并非典型增生、肿瘤直径≥1 cm是复发危险因素(OR=2.83,95%CI:1.44~5.58,P=0.003;OR=2.09,95%CI:1.03~4.26,P=0.040;OR=3.29,95%CI:1.02~10.61,P=0.047);对于周围型乳头状瘤患者,年龄≥45岁、合并非典型增生、肿瘤直径≥1 cm以及肿物切除和区段切除的手术方式是复发危险因素(OR=4.78,95%CI:1.26~18.16,P=0.022;OR=3.84,95%CI:1.19~12.39,P=0.025;OR=1.82,95%CI:1.03~3.19,P=0.038;OR=2.36,95%CI:1.17~4.76,P=0.016;OR=2.64,95%CI:1.38~2.05,P=0.003)。

结论

年龄、合并非典型增生、手术方式、肿瘤直径、肿瘤类型是导管内乳头状瘤复发的影响因素。乳腺腺叶切除术可以有效降低周围型乳头状瘤术后复发,值得临床推广运用。

Objective

To investigate the therapeutic effect of three surgical methods(mass excision, segmental excision and lobectomy) on breast intraductal papilloma and analyze risk factors of recurrence.

Methods

The clinical data of 279 patients with breast intraductal papilloma in the Taiyuan Central Hospital from January 2010 to December 2014 were retrospectively analyzed. The intraoperative and postoperative conditions of patients receiving different surgeries were compared and risk factors of recurrence were analyzed. Measurement data (operation time, intraoperative blood loss, length of hospital stay, operation cost) were compared by univariate analysis of variance. Count data (paresthesia of nipple area, etc.) were compared by χ2 test. Rank data (appearance satisfaction) were compared by Kruskal-Wallis H test. Multivariate analysis was performed by logistic regression analysis.

Results

There was a significant difference in operation cost among three surgical methods [mass excision(n=108): (840.9±361.7) yuan; segmental excision(n=96): (1 840.8±473.6) yuan; lobectomy(n=75): (1 761.2±370.5) yuan; F=969.65, P<0.001]. The operation time, intraoperative blood loss and length of hospital stay presented no significant difference among three groups (F=2.88, 2.40, 2.54; P=0.058, 0.092, 0.081). No significant difference was observed in paresthesia of nipple area and appearance satisfaction among three groups(χ2=1.77, 1.83; P=0.430, 0.400). Univariate analysis showed that age, concurrent atypical hyperplasia, tumor diameter, surgical method and tumor type were related to postoperative recurrence(χ2=3.98, 6.68, 8.56, 21.34, 20.24; P=0.046, 0.010, 0.003, <0.001, <0.001). Logistic regression analysis showed that risk factors of postoperative recurrence included age ≥ 45 years, concurrent atypical hyperplasia, tumor diameter ≥ 1 cm, peripheral papilloma(OR=2.27, 95%CI: 1.00-5.12, P=0.048; OR=4.73, 95%CI: 2.07-10.78, P<0.001; OR=2.17, 95%CI: 1.03-4.56, P=0.040; OR=3.13, 95%CI: 1.25-7.82, P=0.015) and surgical method(compared with lobectomy, the recurrence risk of lumpectomy was 2.65 times as high as that of lobectomy, segmentectomy 2.17 times). Stratified analysis by tumor type showed that for patients with central papilloma, age ≥ 45 years, concurrent atypical hyperplasia and tumor diameter ≥ 1 cm were risk factors of recurrence(OR=2.83, 95%CI: 1.44-5.58, P=0.003; OR=2.09, 95%CI: 1.03-4.26, P=0.040; OR=3.29, 95%CI: 1.02-10.61, P=0.047); for patients with peripheral papilloma, the risk factors of recurrence were age ≥ 45 years, concurrent atypical hyperplasia, tumor diameter ≥ 1 cm, tumor resection and segmental resection(OR=4.78, 95%CI: 1.26~18.16, P=0.022; OR=3.84, 95%CI: 1.19~12.39, P=0.025; OR=1.82, 95%CI: 1.03~3.19, P=0.038; OR=2.36, 95%CI: 1.17~4.76, P=0.016; OR=2.64, 95%CI: 1.38~2.05, P=0.003).

Conclusion

Age, concurrent atypical hyperplasia, surgical method, tumor diameter and tumor type are risk factors of recurrence in patients with intraductal papilloma. Breast lobectomy can effectively reduce postoperative recurrence of peripheral papilloma, worthy of clinical application.

表1 乳腺导管内乳头状瘤复发因素Logistic回归分析变量赋值表
表2 乳腺导管内乳头状瘤患者不同手术方式的术中及术后情况
表3 乳腺导管内乳头状瘤患者术后复发单因素分析
表4 乳腺导管内乳头状瘤患者术后复发多因素分析(n=279)
表5 中央型乳头状瘤患者复发的危险因素分析(n=181)
表6 周围型乳头状瘤患者复发的危险因素分析(n=98)
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