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超声引导下真空辅助切除术与开放式手术治疗乳腺良性叶状肿瘤对术后局部复发的影响

[Effect of ultrasound-guided vacuum-assisted excision verus open surgery for benign phyllodes tumors of breast on postoperative local recurrence].

作者信息

Zhang S L, Lian Z Q, Yu H Y, Wang Y N, Zou S W, Wang Q

机构信息

Department of Breast Diseases, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou 510010, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2020 Feb 1;58(2):110-113. doi: 10.3760/cma.j.issn.0529-5815.2020.02.007.

Abstract

To examine the effect of VAE and open surgery on the postoperativelocal recurrence of benign phyllodes tumors of breast and to investigate the clinical efficacy of VAE in the treatment of benign phyllodes tumors. The clinical data of 128 patients with benign phyllodes tumors of breast admitted to the Guangdong Women and Children Hospital from January 2013 to January 2018 were retrospectively analyzed. All patients were female, aged (37.7±9.1) years (range: 16 to 56 years). Eighty patients underwent ultrasound-guided VAE (minimally invasive group) and 48 patients underwent open surgery (open group). The -test, χ(2) test or Fisher exact probability method were used to compare the clinical characteristics of the two groups of patients. Logistic regression was used to analyze the prognostic factors of postoperative local recurrence. The maximum diameter of tumor in the minimally invasive group was smaller than that in the open group ((20.6±7.4) mm . (42.0±2.0) mm, -7.173, 0.000). The follow-up time was (36.4±1.8) months (range: 12 to 71 months). There were 7 cases of local recurrences during the follow-up period. The local recurrence rates in the minimally invasive and open groups were 5.0% (4/80) and 6.3% (3/48). The results of multivariate analysis showed that the maximum tumor diameter of 25 mm was an independent prognosis factor for postoperativelocal recurrence (0.122, 95: 0.016 to 0.901, 0.039). While surgical procedure, age, menopausal status and history of fibroadenomas in the ipsilateral breast is not an independent prognostic factor for postoperative local recurrence. In the minimally invasive surgery group, the local recurrence rates were 2.9% (2/69) and 2/11 in patients with tumor maximum diameters<25 mm and ≥25 mm, respectively. Local recurrence of breast benign phyllodes tumors is closely related to the tumor size. For patients with tumor diameter25 mm, the postoperative local recurrence rate of VAE is low, which can be used in clinical practice. Intraoperative complete resection to achieve a negative surgical margin should be guaranteed to avoid local recurrence.

摘要

探讨真空辅助旋切术(VAE)与开放手术对乳腺良性叶状肿瘤术后局部复发的影响,并研究VAE治疗乳腺良性叶状肿瘤的临床疗效。回顾性分析2013年1月至2018年1月在广东省妇幼保健院收治的128例乳腺良性叶状肿瘤患者的临床资料。所有患者均为女性,年龄(37.7±9.1)岁(范围:16至56岁)。80例患者接受超声引导下VAE(微创组),48例患者接受开放手术(开放组)。采用t检验、χ²检验或Fisher确切概率法比较两组患者的临床特征。采用Logistic回归分析术后局部复发的预后因素。微创组肿瘤最大直径小于开放组((20.6±7.4)mm 比(42.0±2.0)mm,t=-7.173,P=0.000)。随访时间为(36.4±1.8)个月(范围:12至71个月)。随访期间有7例局部复发。微创组和开放组的局部复发率分别为5.0%(4/80)和6.3%(3/48)。多因素分析结果显示,肿瘤最大直径25 mm是术后局部复发的独立预后因素(β=0.122,95%CI:0.016至0.901,P=0.039)。而手术方式、年龄、绝经状态及同侧乳腺纤维腺瘤病史不是术后局部复发的独立预后因素。在微创手术组中,肿瘤最大直径<25 mm和≥25 mm的患者局部复发率分别为2.9%(2/69)和2/11。乳腺良性叶状肿瘤的局部复发与肿瘤大小密切相关。对于肿瘤直径≥25 mm的患者,VAE术后局部复发率低,可应用于临床实践。术中应保证完整切除以达到手术切缘阴性,避免局部复发。

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