单孔腔镜辅助精准保乳手术与传统保乳手术在早期乳腺癌中的对比研究

doi:10.3877/cma.j.issn.1674-0793.2026.03.004

中华普通外科学文献(电子版) ›› 2026, Vol. 20 ›› Issue (03) : 161 -167. doi: 10.3877/cma.j.issn.1674-0793.2026.03.004

论著

单孔腔镜辅助精准保乳手术与传统保乳手术在早期乳腺癌中的对比研究

张兆祺¹^,², 方燕¹, 刘德月¹, 丁淑宁¹, 王玮¹, 王敏¹, 刘俊¹, 朱丽¹^,^†(

)

¹　200080　上海，上海交通大学医学院附属第一人民医院普外临床医学中心
²　200240　上海，上海交通大学系统生物医学研究院　系统生物医学教育部重点实验室

收稿日期:2025-08-07 出版日期:2026-06-01
通信作者: 朱丽
基金资助:
国家自然科学基金青年科学基金项目(82403399); 系统生物医学教育部重点实验室开放课题项目(KLSB2024KF-06); 促进市级医院临床技能与临床创新三年行动计划（2023-2025年）临床研究数据共享和模拟RCT项目(SHDC2024CRI084); 特色上海领军人才培养计划

Comparison of single-port precision endoscopy-assisted breast-conserving surgery versus conventional breast-conserving surgery in early-stage breast cancer

Zhaoqi Zhang¹^,², Yan Fang¹, Deyue Liu¹, Shuning Ding¹, Wei Wang¹, Min Wang¹, Jun Liu¹, Li Zhu¹^,^†()

¹ Department of General Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200080, China
² Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai 200240, China

Received:2025-08-07 Published:2026-06-01
Corresponding author: Li Zhu

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引用本文：

张兆祺, 方燕, 刘德月, 丁淑宁, 王玮, 王敏, 刘俊, 朱丽. 单孔腔镜辅助精准保乳手术与传统保乳手术在早期乳腺癌中的对比研究[J/OL]. 中华普通外科学文献(电子版), 2026, 20(03): 161-167.

Zhaoqi Zhang, Yan Fang, Deyue Liu, Shuning Ding, Wei Wang, Min Wang, Jun Liu, Li Zhu. Comparison of single-port precision endoscopy-assisted breast-conserving surgery versus conventional breast-conserving surgery in early-stage breast cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(03): 161-167.

目的

通过与传统开放式乳腺癌保乳手术（C-BCS）对比，探索单孔腔镜辅助精准保乳手术（SPE-BCS）在早期乳腺癌治疗中的临床疗效与安全性。

方法

回顾性分析2022年7月至2023年7月在上海市第一人民医院接受SPE-BCS（60例）及C-BCS（80例）治疗的Ⅰ~Ⅱ期女性乳腺癌患者的临床资料，包括术式、手术时间、术中失血量、术后30 d并发症、病理切缘状态及肿瘤学结局等，并评估术后美容效果与生活质量，中位随访时间为30个月。

结果

两组患者的基线特征相似，SPE-BCS组手术时间略短于C-BCS组，术中失血量更少，两组手术切缘最终结果均为阴性，术后并发症发生率相近。术后6个月，SPE-BCS组患者美容满意度更高（P=0.01），术后疼痛更轻，乳房外观和触感更佳。随访期间，两组均未发生局部复发或远处转移。

结论

SPE-BCS在保证肿瘤学疗效的同时，具有切口更小、美容效果更佳、避免热损伤等优势，是C-BCS的可行、安全替代方案。随着技术普及与学习曲线的缩短，有望成为早期乳腺癌保乳治疗的新术式。

关键词: 乳腺肿瘤, 保乳手术, 腔镜辅助, 精准保乳, 微创

Objective

To investigate the clinical efficacy and safety of single-port laparoscopic-assisted precision breast-conserving surgery (SPE-BCS) in the treatment of early-stage breast cancer by comparing it with conventional open breast-conserving surgery (C-BCS).

Methods

The clinical data of female patients with stage Ⅰ–Ⅱ breast cancer who underwent SPE-BCS (60 patients) and C-BCS (80 patients) in Shanghai General Hospital, Shanghai Jiao Tong University, from July 2022 to July 2023 were retrospectively analyzed, including surgical procedures, operative time, intraoperative blood loss, postoperative complications, pathological resection margin status, and oncological outcomes. Postoperative cosmetic outcomes and quality of life were also assessed. The median follow-up time was 30 months.

Results

Baseline characteristics were similar between the two groups. The SPE-BCS group had slightly shorter operative time and less intraoperative blood loss than the C-BCS group. Both groups had negative surgical margins and similar postoperative complication rates. Six months after surgery, patients in the SPE-BCS group had higher cosmetic satisfaction and higher BREAST-Q scores, indicating less postoperative pain and better chest wall comfort. During the follow-up, no local recurrence or distant metastasis occurred in either group.

Conclusions

SPE-BCS offers advantages such as smaller incisions, improved cosmetic results, avoiding heat damage while maintaining oncological efficacy. It is a feasible and safe alternative to C-BCS. With the widespread adoption of this technique and a shortened learning curve, this procedure is expected to become a new surgical procedure in breast-conserving treatment for early-stage breast cancer.

Key words: Breast neoplasms, Breast-conserving surgery, Endoscopy-assisted, Precise breast-conserving surgery, Minimally invasive

图3 腺体后间隙分离完成

图6 深层镜下分离表面，锐性分离后镜下视野

图9 四周切缘会师后标记标本方位，后从切口保护套取出

表1 两组早期乳腺癌患者一般情况的比较

组别	例数	年龄（岁）	体重指数（kg/m²）	肿瘤大小(cm)	肿瘤位置^a[例(%)]		ER[例(%)]		PR[例(%)]		HER-2[例(%)]
组别	例数	年龄（岁）	体重指数（kg/m²）	肿瘤大小(cm)	近侧	远侧	阳性	阴性	阳性	阴性	阳性	阴性
SPE-BCS组	60	45.2±7.1	23.5±1.8	2.8±1.2	41(68.3)	19(31.7)	44(73.3)	16(26.7)	35(58.3)	25(41.7)	17(28.3)	43(71.7)
C-BCS组	80	46.5±6.9	24.1±1.9	2.9±1.4	49(61.2)	31(38.8)	61(76.2)	19(23.8)	49(61.2)	31(38.8)	25(31.2)	55(68.8)
统计值		t=-1.09	t=-1.82	t=-0.45	χ²=0.749		χ²=0.039		χ²=0.030		χ²=0.015
P值		0.280	0.071	0.651	0.387		0.844		0.862		0.903

表1 两组早期乳腺癌患者一般情况的比较

组别	例数	年龄（岁）	体重指数（kg/m²）	肿瘤大小(cm)	肿瘤位置^a[例(%)]		ER[例(%)]		PR[例(%)]		HER-2[例(%)]
组别	例数	年龄（岁）	体重指数（kg/m²）	肿瘤大小(cm)	近侧	远侧	阳性	阴性	阳性	阴性	阳性	阴性
SPE-BCS组	60	45.2±7.1	23.5±1.8	2.8±1.2	41(68.3)	19(31.7)	44(73.3)	16(26.7)	35(58.3)	25(41.7)	17(28.3)	43(71.7)
C-BCS组	80	46.5±6.9	24.1±1.9	2.9±1.4	49(61.2)	31(38.8)	61(76.2)	19(23.8)	49(61.2)	31(38.8)	25(31.2)	55(68.8)
统计值		t=-1.09	t=-1.82	t=-0.45	χ²=0.749		χ²=0.039		χ²=0.030		χ²=0.015
P值		0.280	0.071	0.651	0.387		0.844		0.862		0.903

表2 两种保乳术式在围手术期主要指标及近期预后方面的比较

组别	例数	手术时间（min）	切口长度（cm）	术中失血量（ml）	乳房满意度评分（分）	初次病理切缘[例(%)]		术后血清肿[例(%)]		远处转移[例(%)]
组别	例数	手术时间（min）	切口长度（cm）	术中失血量（ml）	乳房满意度评分（分）	阳性	阴性	阳性	阴性	阳性	阴性
SPE-BCS组	60	90±15	4.5±1.1	31±16	84±8	5(8.3)	55(91.7)	3(5.0)	57(95.0)	0 (0)	60(100.0)
C-BCS组	80	95±20	10.0±1.8	37±17	78±10	6(7.5)	74(92.5)	5(6.3)	75(93.7)	1(1.3)	79(98.7)
统计值		t=-1.69	t=-22.33	t=-2.14	t=3.94	χ²=0.033		χ²=0.099		χ²=0.755
P值		0.093	0.000 1	0.034	0.000 1	0.856		0.753		0.385

表2 两种保乳术式在围手术期主要指标及近期预后方面的比较

组别	例数	手术时间（min）	切口长度（cm）	术中失血量（ml）	乳房满意度评分（分）	初次病理切缘[例(%)]		术后血清肿[例(%)]		远处转移[例(%)]
组别	例数	手术时间（min）	切口长度（cm）	术中失血量（ml）	乳房满意度评分（分）	阳性	阴性	阳性	阴性	阳性	阴性
SPE-BCS组	60	90±15	4.5±1.1	31±16	84±8	5(8.3)	55(91.7)	3(5.0)	57(95.0)	0 (0)	60(100.0)
C-BCS组	80	95±20	10.0±1.8	37±17	78±10	6(7.5)	74(92.5)	5(6.3)	75(93.7)	1(1.3)	79(98.7)
统计值		t=-1.69	t=-22.33	t=-2.14	t=3.94	χ²=0.033		χ²=0.099		χ²=0.755
P值		0.093	0.000 1	0.034	0.000 1	0.856		0.753		0.385

图10 单孔腔镜辅助精准保乳手术（SPE-BCS）的术前和术后外观对比示例　A. 术前；B. 术后第1天，采用腋窝单切口，乳房正面无可见切口，随着术后水肿消退与引流管拔除，乳房表面形态通常较即刻期更为平整

图11 SPE-BCS三步法手术示意图　第一步分离腺体后间隙，第二步精准锐性分离肿瘤表面区域，第三步分离肿瘤四周边缘

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