【摘要】 目的:探讨临床上不能触及的乳房肿块,仅影像学检查表现为恶性钙化乳腺癌的病灶定位方法、手术方法及其治疗效果。方法:对61例乳房体检不能触及肿块、影像学检查也无肿块发现、仅X线钼靶片或B超显示恶性钙化病灶或局部血流丰富的乳腺癌(T1~2N0M0)患者,行术前坐标法立体定位、术中精确定位切除、术毕全数字化平板乳腺摄像机(FFDM)标本复检,同时行广基带血管腺体组织瓣Ⅰ期乳房内成形的保乳手术(单发病灶者)或乳腺癌改良根治术(多中心病灶者)。结果:行保乳手术50例,坐标法定位准确率100%(50/50);病灶切除完整,切缘均为阴性;FFDM复检无病灶残留者;广基带血管腺体组织瓣乳腺Ⅰ期成形结果按JCRT标准达优率86%(43/50),吻合度差值1.5 cm。行乳腺癌改良根治术11例,均为乳腺外弥漫性恶性钙化多中心病灶者。全组61例随访时间6~58个月(中位时间39个月),1例远处转移,无局部复发者。结论:行坐标法定位临床上不可触及肿块的乳腺癌准确有效,切实可行;对单发病灶者在FFDM定位下行保乳手术同时行广基带血管腺体组织瓣Ⅰ期乳房内成形,创伤小,疗效满意,术后乳房美观度优良,尤其适用于国人较小的乳房。更多还原

【Abstract】 Objective:To study the methods of localization and effects of surgical treatment for palpation-negative breast cancer.Methods:From November 2003 to August 2007,61 patients with neither touchable mass nor mass image in radiography were diagnosed early breast cancer(T1-2N0M0)according to malignant calcification focus shown by radiography with molybdenum tube or rich local blood supply shown by B-type ultrasonic examination in Jiangsu Province Tumor Hospital.Patients with single lesion received breast-conserving surgery,which meaned the cancer lesion was excised precisely with the aid of preoperative localization by FFDM coordinate orientation,and breast reconstruction was accomphished synchronously by wide-based gland tissue flap stageⅠbreast reconstruction.patients with multiple lesion received modified radical mastectomy.Results:In the breast-conserving surgery given to the 50 patients,the accuracy of localization was 100%(50/50);breast single focus were excised completely with margin negative by FFDM and pathological examination;the superior rate of mammaplasty was 86%(43/50) according to JCRT.Complience difference was 1.5cm.Modified radical mastectomy on breast cancer was given to the 11 patients with breast extramammary diffusive calcified focus.The follow-up time was 6 to 58 months in 61 patients(average time was 39 months),1 case distant metastases and no local recurrence was observed.Conclusion:Lesion localization in patients with breast single focus,breast-conserving surgery followed by synchronous wide-based gland-tissue flap stageⅠbreast reconstruction is a new recommendable technique for breast minimally invasive surgery for its simple maneuver,minimal invasion and produces a fairly well-shaped.Such treatment is especially suitable for Chinese female patients with small breast.更多还原