Yamamoto Daigo, Yamada Masanori, Okugawa Homa, Yonekura Yasunori, Tanaka Kanji
Department of Surgery, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan.
Oncol Rep. 2003 Nov-Dec;10(6):1729-32.
Breast conserving therapy (BCT) was originally developed to achieve the same survival outcome as mastectomy while improving the quality of life. In fact, this approach resulted in high local control rates, but 30% of patients treated with BCT using electrocautery had a fair or poor cosmetic result at the 3-year follow-up. In 106 patients with stage I and II breast cancer treated by wide excision and axillary dissection using scalpel plus scissor or electrocautery followed by radiation therapy, the histological damage and cosmetic results were analyzed. The duration of operation in the scalpel plus scissor group was shorter than that in the electrocautery group, although blood loss was greater. The electrocautery caused extensive histological tissue damage to the stump compared with the scalpel plus scissor group. The cell death by TUNEL method was significantly increased on electrocautery groups. In addition, although the global cosmetic result of the electrocautery group was similar to that of the scalpel plus scissor group after surgery, the scalpel plus scissor group had a much better cosmetic outcome after surgery and radiation therapy at the 3-year follow-up. Clinical tumor size T1 and pathological tumor size over 2 cm were factors that negatively affected the cosmetic score after surgery in each group. Scalpel plus scissor in breast conserving surgery has less tissue damage and better cosmetic results at the 3-year follow-up.
保乳治疗（BCT）最初是为了在提高生活质量的同时，实现与乳房切除术相同的生存结果而开发的。事实上，这种方法导致了较高的局部控制率，但在3年随访中，30%接受电灼保乳治疗的患者美容效果一般或较差。对106例I期和II期乳腺癌患者进行了分析，这些患者采用手术刀加剪刀或电灼进行广泛切除和腋窝清扫，随后进行放射治疗，分析其组织学损伤和美容效果。手术刀加剪刀组的手术时间比电灼组短，尽管失血量更大。与手术刀加剪刀组相比，电灼对残端造成了广泛的组织学损伤。电灼组通过TUNEL法检测的细胞死亡显著增加。此外，尽管电灼组术后的整体美容效果与手术刀加剪刀组相似，但在3年随访时，手术刀加剪刀组在手术和放射治疗后的美容效果要好得多。临床肿瘤大小T1和病理肿瘤大小超过2 cm是影响每组术后美容评分的负面因素。在保乳手术中，手术刀加剪刀在3年随访时组织损伤较小，美容效果更好。
