保乳手术对≤35岁女性三阴性乳腺癌的疗效及预后探讨

李崎 吴旻骅 吴伟主

[摘要] 目的 探討保乳手术对≤35岁三阴性乳腺癌的疗效及预后。 方法 选取2011年7月～2016年7月在我院治疗的60例≤35岁三阴性乳腺癌者作为研究对象，作为观察组，另选择2011年7月～2016年7月同期行改良根治术的三阴性乳腺癌者60例，作为对照组，比较两组的手术观察指标及并发症及局部复发、远处转移、1年生存率情况。 结果 观察组患者的手术时间明显短于对照组、差异有显著性（P<0.05）。观察组患者的术中出血量明显少于对照组，差异有显著性（P<0.05）。观察组患者术后并发症发生率明显少于对照组，差异有显著性（6.67% vs 20.00%，P<0.05）。其中，观察组术后发生皮下积液2例，皮瓣缺血2例，对照组术后发生皮下积液3例，皮瓣缺血3例，患侧上肢肿胀6例。随访1年，结果显示，观察组患者局部复发率、远处转移率显著低于对照组，差异有显著性（P<0.05）。但两组患者术后1年生存率比较，差异无显著性（98.33% vs 83.33%，P>0.05）。其中观察组死亡1例，术后11个月死于脑转移：对照组2例患者术后6个、12个月分别出现肝转移死亡。 结论 对≤35岁三阴性乳腺癌患者采取保乳手术效果确切，能显著减少术后复发及远处转移，提高手术成功率。

[关键词] 女性三阴性乳腺癌；保乳手术；并发症；预后

[中图分类号] R737.9 [文献标识码] B [文章编号] 1673-9701（2018）15-0054-03

Efficacy and prognosis of breast conserving surgery for triple negative breast cancer in women ≤35 years

LI Qi WU Minhua WU Weizhu

Department of Thyroid and Breast Surgery， Ningbo Medical Center Li Huili Eastern Hospital， Ningbo 315000， China

[Abstract] Objective To investigate the effect and prognosis of breast conserving surgery on triple-negative breast cancer patients ≤35 years old. Methods 60 cases of ≤ 35-year-old triple negative breast cancer from July 2011 to July 2016 in our hospital were selected as the observation group. Other 60 triple-negative breast cancer patients who underwent modified radical mastectomy from July 2011 to July 2016 at the same period were selected as control group. The surgical observation index， complications， local recurrence， distant metastasis and 1-year survival rate between the two groups were compared. Results The operation time of the observation group was significantly shorter than that of the control group， and the difference was significant（P<0.05）. The intraoperative blood loss in the observation group was significantly less than that of the control group. There was significant difference between the two groups（P<0.05）. The incidence of postoperative complications in the observation group was significantly less than that in the control group. There was significant difference between the two groups （6.67% vs 20.00%， P<0.05）. Among them， there were 2 cases of subcutaneous effusion， 2 cases of flap ischemia in the observation group. And there were 3 cases of subcutaneous effusion， 3 cases of ischemic skin flap and 6 cases of upper limb swelling in the affected side in the control group. The follow-up of 1 year showed that the local recurrence rate and distant metastasis rate in the observation group was significantly lower than that in the control group. There was significant difference between the two groups（P<0.05）. However， there was no significant difference in one-year survival rate between the two groups （98.33% vs 83.33%， P>0.05）. One case died in the observation group and died of brain metastases at 11 months after operation. Two patients in the control group died of liver metastases at 6 months and 12 months after operation. Conclusion Breast-conserving surgery for triple-negative breast cancer patients≤35 years has definite effect， which can significantly reduce postoperative recurrence and distant metastasis and improve the success rate of operation.

[Key words] Female triple negative breast cancer； Breast conserving surgery； Complications； Prognosis

三阴性乳腺癌（triple-negative breast cancer，TNBC）是指雌激素受体（estrogen receptor，ER）、孕激素受体（progesterone receptor，PR）、表皮生长因子受体2（HerbB-2，Her-2）均为阴性的乳腺癌，占乳腺癌发病总数的15%～20%[1]，患者发病年龄轻，易发生局部复发和远处转移，预后差，脑转移发生率高，死亡风险较非三阴性乳腺癌明显[2]。手术切除是治疗三阴性乳腺癌的首选方案，保乳手术与改良根治术是常用的手术方法。本研究旨在探讨保乳手术对≤35岁三阴性乳腺癌的疗效及术后预后情况，并与传统改良根治术进行比较，现报道如下。

1 资料与方法

1.1 临床资料

选取2011年7月～2016年7月在我院治疗的60例≤35岁三阴性乳腺癌者作为研究对象，作为观察组，均采取保乳手术。首诊年龄≤35岁，均为女性，均有完整的临床资料，免疫组化检查结果（包括ER、PR及 HER-2均为阴性），平均（29.1±7.3）岁。……