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目的探讨乳腺癌保乳手术切缘阳性与多因素的关系。方法2003年7月至2004年12月对112例原发性乳腺癌行保乳手术。0期9例,Ⅰ期51例,Ⅱ期50例,Ⅲ期2例,采用单因素和多因素分析切缘阳性与临床病理因素的关系。结果单因素分析,手术术式、乳腺X线片微钙化范围、组织学分级及EIC是影响切缘阳性与否的重要因素(P<0·05)。多因素分析,影响切缘阳性的因素依次为:手术术式;组织学分级;广泛导管内癌成分(EIC),微钙化范围。结论乳腺癌保乳手术前,常规高质量乳房X线(如全数字化钼铑双靶)检查和切缘距病灶≥1cm对防止切缘阳性有重要意义。环行连续切取切缘及近肿瘤缘至少两张切片病理检查能有效预防切缘的假阴性。
Objective To investigate the relationship between breast cancer positive margin and multiple factors in breast conserving surgery. Methods From July 2003 to December 2004, 112 cases of primary breast cancer underwent breast conserving surgery. There were 9 cases of stage 0, 51 cases of stage Ⅰ, 50 cases of stage Ⅱ and 2 cases of stage Ⅲ. Univariate and multivariate analysis was used to analyze the relationship between the positive margins and clinicopathological factors. Results Univariate analysis, surgical procedures, the range of mammography microcalcifications, histological grade and EIC were the important factors influencing the positive or negative margins (P <0.05). Multivariate analysis, the factors affecting the positive margins were: surgical procedures; histological grading; extensive intraductal cancer components (EIC), the scope of micro-calcifications. Conclusion breast conserving surgery before surgery, conventional high-quality mammography (such as all-digital molybdenum rhodium double target) examination and cutting margin from the lesion ≥ 1cm to prevent positive margins of great significance. Circumferentially cut the edge of the tumor and near the edge of at least two sections of the pathological examination can effectively prevent the margin of the false negative.