摘要
目的介绍乳腺癌保留乳房治疗的手术模式、放射治疗技术、放疗并发症及美容效果。方法１９８５年８月至１９９６年６月共６５例女性乳腺癌病人接受了保留乳房术加术后根治性放疗，其中，Ⅰ期２９例，Ⅱ期３４例，Ⅲ期２例，肿瘤位于外上象限者５２例，其他象限者１３例。手术模式为乳房肿瘤扩大切除术加腋淋巴结清扫术。全部病人均于术后２个月内接受根治性放疗，各野的中位剂量分别为内乳ＤＴ５３．２Ｇｙ、锁上ＤＴ５５．４Ｇｙ、全乳切线ＤＴ４９．２Ｇｙ、瘤床追加ＤＴ１４．６Ｇｙ。结果病人的３年和５年生存率分别为９３．６％、９１．７％；出现急性放射反应者１３例，占２０％；出现放射性肺炎／肺纤维化者４例，发生率６％；出现乳房／胸壁纤维化者２例。治疗后美容效果医患均满意者占９２．３％。结论早期乳腺癌保留乳房加术后根治性放疗与根治性手术疗效相同，只要选择病例恰当并掌握好手术模式和放疗技术，其手术和放射并发症的发生率是可以接受的，而且具有良好的美容效果。
Objective To introduce the operative model,radiotherapeutic method,radiation-induced complication and cosmetic result of conservingbreast therapy on patients with breast cancer.Method From August 1985 to June 1996,total of 65 patients with breast cancer undertaken conserving breast operation and postoperative radical radiotherapy,of them,29 in stage Ⅰ,34 in stage Ⅱ,2 in stage Ⅲ.The tumor located in upper outer quadrant of the breast in 52 cases,the other quadrant in 13 cases.The operative model was quadrantectomy plus axillary dissection.All of the patients received radical radiotherapy in 2 months after opeation,the median doses given in the fields were DT 53.2Gy in the intramammary field,DT 55.4Gy in the supraclavicular,DT 49.2Gy in the breast tangential field,DT 14.6Gy in the breast boost field,respectively.Result The 3and 5year survival rates were 93.6% and 91.7%.The acute radiating responses appeared in 13 cases(20%).Four patients developed radiation-induced pneumonitis or pneumofibrosis(6%),2 developed breast or thoratic fibrosis.The doctor and the patients all satisfied the cosmetic results in 60 cases,acting as 92.3%.Conclusion The survival rate of the patients received conserving breast operation plus axillary dissection is similar to those received radical operation.Only if the cases are selected well and the operative model and radiotherapeutic technology are used seemly,the rates of complications relative to the operation and radiotherapy are receivable.The cosmetic results is superior.
关键词
乳腺癌
乳房保留
放射疗法
并发症
美容
Breast cancer Breastconserving therapy Radiotherapy Complication Cosmesis
